Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

Wataru Yamadera, Shintaro Chiba, Masayuki Iwashita, Ryo Aoki, Daisuke Harada, Miki Sato, Hiroto Moriwaki, Keita Obuchi, Motohiro Ozone, Seiji Nishino, Hiroshi Itoh, Kazuhiko Nakayama

1Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan; 2Stanford Sleep and Circadian Neurobiology Lab- oratory, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, USA.
Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.
Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan;.
Shinbashi Sleep Mental Clinic, Tokyo, Japan..
Stanford Sleep and Circadian Neurobiology Lab- oratory, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, USA.
Stanford Sleep and Circadian Neurobiology Lab- oratory, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, USA; 3Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.

DOI: 10.4236/ijcm.2012.33039                

Abstract

The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessive daytime sleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pressure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively; %usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale; JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 patients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.

Keywords

Obstructive Sleep Apnea Syndrome; Continuous Positive Airway Pressure; Excessive Daytime Sleepiness; Japanese Version of the Pittsburgh Sleep Quality Index (PSQI-J); Behavioral Induced Insufficient Sleep Syndrome

Conflicts of Interest

The authors declare no conflicts of interest.

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