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Sleep-wake misperception in sleep apnea patients undergoing diagnostic versus titration polysomnography.

ABSTRACT: Insomnia is commonly co-morbid with obstructive sleep apnea. Among patients reporting insomnia symptoms, sleep misperception occurs when self-reported sleep duration under-estimates objective measures. Misperception represents a clinical challenge since insomnia management is based entirely on patient self-report. We tested the hypothesis that misperception occurring in sleep apnea patients would improve with subsequent treatment.We compared subjective sleep-wake reports with objective sleep in adults with obstructive sleep apnea (n=405) in two nights of polysomnography (diagnostic and treatment) within a median interval of 92 days.Sleep latency was generally over-estimated, while wake after sleep onset and number of awakenings were under-estimated. None of these estimations differed between diagnostic and treatment polysomnograms. We observed a large spectrum of total sleep time misperception values during the diagnostic polysomnogram, with one third of the cohort under-estimating their total sleep time by at least 60 min. Of those with >60 minute misperception, we observed improved total sleep time perception during treatment polysomnography. Improved perception correlated with improvements in self-reported sleep quality and response confidence. We found no polysomnogram or demographic predictors of total sleep time misperception for the diagnostic polysomnogram, nor did we find objective correlates of improved perception during titration.Our results suggest that misperception may improve with treatment of obstructive sleep apnea in patients who also exhibit misperception. Within subject changes in misperception are consistent with misperception being, at least to some extent, a state characteristic, which has implications for management of patients with comorbid insomnia and sleep apnea.

SUBMITTER: Castillo J

PROVIDER: S-EPMC4405154 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Sleep-wake misperception in sleep apnea patients undergoing diagnostic versus titration polysomnography.

Castillo Jelina J Goparaju Balaji B Bianchi Matt T MT

Journal of psychosomatic research 20140322 5

<h4>Objective</h4>Insomnia is commonly co-morbid with obstructive sleep apnea. Among patients reporting insomnia symptoms, sleep misperception occurs when self-reported sleep duration under-estimates objective measures. Misperception represents a clinical challenge since insomnia management is based entirely on patient self-report. We tested the hypothesis that misperception occurring in sleep apnea patients would improve with subsequent treatment.<h4>Methods</h4>We compared subjective sleep-wak ...[more]

PMID: 24745776

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Project description:RationaleTherapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes ("traits") if a clinically applicable approach were available.ObjectivesHere we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography.MethodsBased on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g., during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in patients with OSA (N = 29), using a novel automated noninvasive method to estimate ventilatory drive (polysomnographic method) and using "gold standard" ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using continuous positive airway pressure manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N = 11).Measurements and main resultsPolysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R = 0.83, P < 0.0001; and R = 0.76, P < 0.0001; respectively) and using continuous positive airway pressure manipulation (R = 0.67, P < 0.0001; and R = 0.64, P < 0.001; respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy, 69-86% vs. ventilatory drive measures; P < 0.05). Traits were near-identical using nasal pressure versus pneumotach (N = 11, R ≥ 0.98, both traits; P < 0.001).ConclusionsPhenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling noninvasive phenotyping in the clinic. Our approach may facilitate precision therapeutic interventions for OSA.

Project description:Heart rate variability (HRV) can reflect the changes in the autonomic nervous system (ANS) that are affected by apnea or hypopnea events among patients with obstructive sleep apnea hypopnea syndrome (OSAHS). To evaluate the possibility of using HRV to screen for OSAHS, we investigated the relationship between HRV and polysomnography (PSG) diagnostic indices using electrocardiography (ECG) and PSG data from 25 patients with OSAHS and 27 healthy participants. We evaluated the relationship between various PSG diagnostic indices (including the apnea hypopnea index [AHI], micro-arousal index [MI], oxygen desaturation index [ODI]) and heart rate variability (HRV) parameters using Spearman's correlation analysis. Moreover, we used multiple linear regression analyses to construct linear models for the AHI, MI, and ODI. In our analysis, the AHI was significantly associated with relative powers of very low frequency (VLF [%]) (r = 0.641, P = 0.001), relative powers of high frequency (HF [%]) (r = -0.586, P = 0.002), ratio between low frequency and high frequency powers (LF/HF) (r = 0.545, P = 0.049), normalized powers of low frequency (LF [n.u.]) (r = 0.506, P = 0.004), and normalized powers of high frequency (HF [n.u.]) (r = -0.506, P = 0.010) among patients with OSAHS. The MI was significantly related to standard deviation of RR intervals (SDNN) (r = 0.550, P = 0.031), VLF [%] (r = 0.626, P = 0.001), HF [%] (r = -0.632, P = 0.001), LF/HF (r = 0.591, P = 0.011), LF [n.u.] (r = 0.553, P = 0.004), HF [n.u.] (r = -0.553, P = 0.004), and absolute powers of very low frequency (VLF [abs]) (r = 0.525, P = 0.007) among patients with OSAHS. The ODI was significantly correlated with VLF [%] (r = 0.617, P = 0.001), HF [%] (r = -0.574, P = 0.003), LF [n.u.] (r = 0.510, P = 0.012), and HF [n.u.] (r = -0.510, P = 0.012) among patients with OSAHS. The linear models for the PSG diagnostic indices were AHI = -38.357+1.318VLF [%], MI = -13.389+11.297LF/HF+0.266SDNN, and ODI = -55.588+1.715VLF [%]. However, the PSG diagnostic indices were not related to the HRV parameters among healthy participants. Our analysis suggests that HRV parameters are powerful tools to screen for OSAHS patients in place of PSG monitoring.

Project description:BackgroundThe amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in an individual patient diagnosed with obstructive sleep apnea. This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography (PSG), in analogy with continuous positive airway pressure (CPAP) titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported.MethodsThis randomized crossover trial will compare DISE-assisted titration to PSG-guided titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using level 1 sleep studies.DiscussionCurrently, the optimal titration of MAD therapy is most often based on 'trial and error'. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results for such a procedure are as yet available. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods.Trial registrationClinicalTrials.gov, NCT03716648 . Registered on 23 October 2018.

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Sleep-wake misperception in sleep apnea patients undergoing diagnostic versus titration polysomnography.

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Sleep-wake misperception in sleep apnea patients undergoing diagnostic versus titration polysomnography.

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