Habitual Sleep Pattern, Anxiety And Depression Are Predictive Of Excessive Daytime Sleepiness In A Large-scale Clinical Samples Of Obstructive Sleep Apnea
Date Issued
2020-06
Author(s)
Shin-Fang Chang, Wen-Chi Huang, Yu-Ting Liu, Pei-Lin Lee
Abstract
Introduction: Excessive daytime sleepiness (EDS) is a common symptom that patients with obstructive sleep apnea (OSA) seek medical attention
for. Prevalence ranged from 20% to 60%. Previous studies reported factors associated with EDS included age, body mass index (BMI), depression,
and OSA severity. In most studies, the sample size was small, participants having specific co-morbidities, and the definitions of EDS was
heterogeneous. Moreover, the association between anxiety, depression, habitual sleep pattern, and EDS has not been widely studied. Therefore,
the present study aims to investigate the prevalence of EDS and associated factors, especially anxiety, depression, and habitual sleep pattern, in a
large-scale clinical sample.
Methods: Data was prospectively collected from 8,081 adult patients who underwent initial overnight polysomnography (PSG) for the first time
were referred from 2009 to 2016. Patients with total recording time less than 240 minutes and missing data were excluded. Data collected include
demographics, anthropometrics, co-morbidities, and self-reported habitual sleep patterns. Subjective sleepiness was assessed by the Epworth
Sleepiness Scale (ESS) with EDS defined as ESS ≧10. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS).
The stepwise forward Logistic regression was used to identified predictors for EDS.
Results: In 5,780 (82.6%) patients with OSA (apnea-hypopnea index, AHI≧5/h), mean age was 63.9±0.2 yr, BMI was 27.7±0.1, and ESS was
10.4±0.1 and 80.5% were male. Prevalence of EDS in all OSA patients was 55.1% where the patients with severe OSA had higher prevalence
(59.8%) than that in mild (49.5%) and moderate OSA (51.8%). Anxiety (OR: 2.036, 95% CI:1.153-1.502), depression (OR: 1.159, 95% CI:1.01-1.33),
and short sleep (<6hr/night) (OR:1.316, 95% CI:1.32,1.70) were top three risk factors for EDS. Other risk factors for EDS included AHI, arousal
index, % total sleep time with SpO2<90%, %REM, smoking while hypnotic use and long sleep (≧ 8hr/night) were associated with lower risk.
Conclusion: Anxiety, depression, short sleep are predictive and OSA severity are predictive of EDS while long sleep was associated with lower risk.
Support: National Taiwan University (NTU-EPR-104R8951-1; 105R8951-1; 106R880301), Center of electronics technology integration
(NTU-107L900502, 108L900502) by the Ministry of Education in Taiwan and MediaTek Inc (201802034RIND).
Event(s)
SLEEP
Type
conference paper