All Title Author
Keywords Abstract

The Role of Daytime Sleepiness in Psychosocial Outcomes after Treatment for Obstructive Sleep Apnea

DOI: 10.1155/2013/140725

Full-Text   Cite this paper   Add to My Lib


We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG) and compared on measures of daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburg Sleep Quality Index), mood (Beck Depression Inventory, Profile of Mood States), and functional outcomes (Functional Outcomes of Sleep Questionnaire). After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment. 1. Introduction Individuals with obstructive sleep apnea-hypopnea syndrome (OSA) experience excessive daytime sleepiness and fatigue, decreased cognitive function and mood changes, resulting in significant, negative consequences in work and driving performance, and lowered quality of life (see review by [1]). Therefore, the evaluation of OSA treatment on both nighttime and daytime consequences of OSA is critical. The most obvious consequence and manifestation of untreated OSA are probably subjective sleepiness and high propensity to fall asleep during the daytime. Engleman and Douglas [2] reviewed 29 studies that measured sleepiness and concluded that at least moderate impairments in terms of excessive daytime sleepiness are indicated in patients with OSA. Accumulating evidence suggests that the main causes of daytime sleepiness in patients with OSA are sleep fragmentation and sleep architecture disruptions [3]. Some propose that sleepiness of patients with more severe OSA may be more related to the breathing disruptions and the associated nocturnal hypoxemia (e.g., [4]). An association between OSA and mood disorders is revealed by studies reporting their comorbidity


[1]  C. Guilleminault and A. G. Bassiri, “Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome and the upper airway resistance syndrome,” in Principles and Practice of Sleep Medicine, M. H. Kryger, T. Roth, and W. C. Dement, Eds., pp. 1043–1052, Elsevier Saunders, Philadelphia, Pa, USA, 2005.
[2]  H. M. Engleman and N. J. Douglas, “Sleep 4: sleepiness, cognitive function, and quality of life in obstructive apnoea/hypopnoea syndrome,” Thorax, vol. 59, no. 7, pp. 618–622, 2004.
[3]  M. Nowak, J. Kornhuber, and R. Meyrer, “Daytime impairment and neurodegeneration in OSAS,” Sleep, vol. 29, no. 12, pp. 1521–1530, 2006.
[4]  C. Vernet, S. Redolfi, V. Attali et al., “Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms,” European Respiratory Journal, vol. 38, no. 1, pp. 98–105, 2011.
[5]  M. M. Ohayon, “The effects of breathing-related sleep disorders on mood disturbances in the general population,” Journal of Clinical Psychiatry, vol. 64, pp. 1195–1200, 2003.
[6]  S. Mosko, M. Zetin, S. Glen et al., “Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients,” Journal of Clinical Psychology, vol. 45, no. 1, pp. 51–60, 1989.
[7]  P. E. Peppard, M. Szklo-Coxe, K. M. Hla, and T. Young, “Longitudinal association of sleep-related breathing disorder and depression,” Archives of Internal Medicine, vol. 166, no. 16, pp. 1709–1715, 2006.
[8]  W. Cassel, “Sleep apnea and personality,” Sleep, vol. 16, no. 8, pp. S56–S58, 1993.
[9]  W. A. Bardwell, C. C. Berry, S. Ancoli-Israel, and J. E. Dimsdale, “Psychological correlates of sleep apnea,” Journal of Psychosomatic Research, vol. 47, no. 6, pp. 583–596, 1999.
[10]  K. Cheshire, H. Engleman, I. Deary, C. Shapiro, and N. J. Douglas, “Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome,” Archives of Internal Medicine, vol. 152, no. 3, pp. 538–541, 1992.
[11]  W. Yue, W. Hao, P. Liu, T. Liu, M. Ni, and Q. Guo, “A case-control study on psychological symptoms in sleep apnea-hypopnea syndrome,” Canadian Journal of Psychiatry, vol. 48, no. 5, pp. 318–323, 2003.
[12]  S. E. Martin, H. M. Engleman, I. J. Deary, and N. J. Douglas, “The effect of sleep fragmentation on daytime function,” American Journal of Respiratory and Critical Care Medicine, vol. 153, no. 4, pp. 1328–1332, 1996.
[13]  S. R. Patel, D. P. White, A. Malhotra, M. L. Stanchina, and N. T. Ayas, “Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea results of a meta-analysis,” Archives of Internal Medicine, vol. 163, no. 5, pp. 565–571, 2003.
[14]  Y. Nussbaumer, K. E. Bloch, T. Genser, and R. Thurnheer, “Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea,” Chest, vol. 129, no. 3, pp. 638–643, 2006.
[15]  A. I. Sánchez, G. Buela-Casal, M. P. Bermúdez, and F. Casas-Maldonado, “The effects of continuous positive air pressure treatment on anxiety and depression levels in apnea patients,” Psychiatry and Clinical Neurosciences, vol. 55, no. 6, pp. 641–646, 2001.
[16]  H. M. Engleman, R. N. Kingshott, P. K. Wraith, T. W. Mackay, I. J. Deary, and N. J. Douglas, “Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome,” American Journal of Respiratory and Critical Care Medicine, vol. 159, no. 2, pp. 461–467, 1999.
[17]  M. Barnes, D. Houston, C. J. Worsnop et al., “A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea,” American Journal of Respiratory and Critical Care Medicine, vol. 165, no. 6, pp. 773–780, 2002.
[18]  M. J. Sateia, “Neuropsychological impairment and quality of life in obstructive sleep apnea,” Clinics in Chest Medicine, vol. 24, no. 2, pp. 249–259, 2003.
[19]  E. Y. Y. Lau, G. A. Eskes, D. L. Morrison, M. Rajda, and K. F. Spurr, “Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure,” Journal of the International Neuropsychological Society, vol. 16, no. 6, pp. 1077–1088, 2010.
[20]  A. Rechtschaffen and A. Kales, A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects, UCLA Brain Information Service/Brain Research Institute, Los Angeles, Calif, USA, 1968.
[21]  M. W. Johns, “A new method for measuring daytime sleepiness: the Epworth sleepiness scale,” Sleep, vol. 14, no. 6, pp. 540–545, 1991.
[22]  M. W. Johns, “Reliability and factor analysis of the Epworth Sleepiness Scale,” Sleep, vol. 15, no. 4, pp. 376–381, 1992.
[23]  N. Hartenbaum, N. Collop, I. M. Rosen et al., “Sleep apnea and commercial motor vehicle operators: statement from the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation,” Chest, vol. 130, no. 3, pp. 902–905, 2006.
[24]  F. M. Hardinge, D. J. Pitson, and J. R. Stradling, “Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airways pressure in patients with obstructive sleep apnoea,” Respiratory Medicine, vol. 89, no. 9, pp. 617–620, 1995.
[25]  M. W. Johns, “Daytime sleepiness, snoring, and obstructive sleep apnea; The Epworth Sleepiness Scale,” Chest, vol. 103, no. 1, pp. 30–36, 1993.
[26]  S. Smith and K. A. Sullivan, “A reliable change index (RCI) for the Epworth sleepiness scale (ESS),” Sleep Medicine, vol. 9, no. 1, p. 102, 2007.
[27]  D. J. Buysse, C. F. Reynolds, T. H. Monk, S. R. Berman, and D. J. Kupfer, “The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research,” Psychiatry Research, vol. 28, no. 2, pp. 193–213, 1989.
[28]  A. T. Beck, Beck Depression Inventory, The Psychological Corporation, San Antonio, Tex, USA, 1987.
[29]  D. M. McNair, M. Lorr, and L. F. Druppleman, EITS Manual for the Profile of Mood States, Education and Industrial Test Services, San Diego, Calif, USA, 1971.
[30]  W. A. Bardwell, S. Ancoli-Israel, and J. E. Dimsdale, “Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study,” Journal of Affective Disorders, vol. 97, no. 1–3, pp. 181–186, 2007.
[31]  B.-H. Yu, S. Ancoli-Israel, and J. E. Dimsdale, “Effect of CPAP treatment on mood states in patients with sleep apnea,” Journal of Psychiatric Research, vol. 33, no. 5, pp. 427–432, 1999.
[32]  T. E. Weaver, A. M. Laizner, L. K. Evans et al., “An instrument to measure functional status outcomes for disorders of excessive sleepiness,” Sleep, vol. 20, no. 10, pp. 835–843, 1997.
[33]  M. R. M. Visser, F. J. Oort, and M. A. G. Sprangers, “Methods to detect response shift in quality of life data: a convergent validity study,” Quality of Life Research, vol. 14, no. 3, pp. 629–639, 2005.
[34]  M. J. Ramos Platón and J. Espinar Sierra, “Changes in psychopathological symptoms in sleep apnea patients after treatment with nasal continuous positive airway pressure,” International Journal of Neuroscience, vol. 62, no. 3-4, pp. 173–195, 1992.
[35]  J. Santamaria, A. Iranzo, J. Ma Montserrat, and J. de Pablo, “Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment,” Sleep Medicine Reviews, vol. 11, no. 3, pp. 195–207, 2007.
[36]  M. W. Johns, “Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard,” Journal of Sleep Research, vol. 9, no. 1, pp. 5–11, 2000.
[37]  J. Feng, Q. Y. He, X. L. Zhang, and B. Y. Chen, “Epworth Sleepiness Scale may be an indicator for blood pressure profile and prevalence of coronary artery disease and cerebrovascular disease in patients with obstructive sleep apnea,” Sleep and Breathing, vol. 16, no. 1, pp. 31–40, 2011.
[38]  S. M. H. A. Araujo, V. M. Bruin, E. F. Daher, C. A. Medeiros, G. H. Almeida, and P. F. Bruin, “Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients,” Scandinavian Journal of Urology and Nephrology, vol. 45, no. 5, pp. 359–364, 2011.
[39]  C. Kline, G. B. Ewing, J. B. Burch, et al., “Exercise training improves selected aspects of daytime functioning in adults with obstructive sleep apnea,” Journal of Clinical Sleep Medicine, vol. 8, no. 4, pp. 357–365, 2012.
[40]  S. Lee, “Depression in sleep apnea: a different view,” Journal of Clinical Psychiatry, vol. 51, no. 7, pp. 309–310, 1990.
[41]  B. A. Phillips, D. T. R. Berry, and T. C. Lipke-Molby, “Sleep-disordered breathing in healthy, aged persons: fifth and final year follow-up,” Chest, vol. 110, no. 3, pp. 654–658, 1996.
[42]  G. Pillar and P. Lavie, “Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index,” Chest, vol. 114, no. 3, pp. 697–703, 1998.
[43]  C. J. Stepnowky, J. J. Palau, T. Zamora, S. Ancoli-Israel, and J. S. Loredo, “Fatigue in sleep apnea: the role fo depressive symptoms and self-reported sleep quality,” Sleep Medicine, vol. 12, no. 9, pp. 832–837, 2011.
[44]  A. I. Sánchez, P. Martínez, E. Miró, W. A. Bardwell, and G. Buela-Casal, “CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function,” Sleep Medicine Reviews, vol. 13, no. 3, pp. 223–233, 2009.
[45]  S. Rollnick, W. R. Miller, and C. C. Butler, Motivational Interviewing in Health Care: Helping Patients Change Behavior, Guilford Press, 2008.


comments powered by Disqus