Phenotyping patients treated for obstructive sleep apnea with persistent objective impaired alertness or subjective sleepiness
Sleep Medicine. 2024-10-01; 122: 221-229
DOI: 10.1016/j.sleep.2024.08.001
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1. Sleep Med. 2024 Oct;122:221-229. doi: 10.1016/j.sleep.2024.08.001. Epub 2024
Aug 23.
Phenotyping patients treated for obstructive sleep apnea with persistent
objective impaired alertness or subjective sleepiness.
Tankéré P(1), Taillard J(2), Stauffer E(3), Petitjean T(4), Berthomier C(5),
Strauss M(6), Tamisier R(7), Peter-Derex L(8).
Author information:
(1)Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon,
Lyon, France; Grenoble Alpes University, HP2 Laboratory (Hypoxia
Pathophysiology), INSERM U1300 Grenoble, France; Lyon Neuroscience Research
Center, PAM Team, INSERM U1028 / CNRS UMR 5292 / Lyon 1 University, Lyon,
France.
(2)Sommeil, Addiction et Neuropsychiatrie, Université de Bordeaux, SANPSY, USR
3413, F-33000 Bordeaux, France.
(3)Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon,
Lyon, France; Laboratory LIBM EA7424, Team Vascular Biology and Red Blood Cell,
University of Lyon 1, Lyon, France.
(4)Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon,
Lyon, France.
(5)Physip, Paris, France.
(6)Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles
(H.U.B), CUB Hôpital Érasme, Services de Neurologie, Psychiatrie et laboratoire
du sommeil, Brussells, Belgium; Neuropsychology and Functional Imaging Research
Group (UR2NF), Center for Research in Cognition and Neurosciences and ULB
Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium.
(7)Grenoble Alpes University, HP2 Laboratory (Hypoxia Pathophysiology), INSERM
U1300 Grenoble, France; Grenoble University Hospital, Department of Physiology,
Sleep Laboratory, BP 53, 38041 Grenoble, Cedex 9, France.
(8)Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon,
Lyon, France; Lyon Neuroscience Research Center, PAM Team, INSERM U1028 / CNRS
UMR 5292 / Lyon 1 University, Lyon, France. Electronic address:
.
BACKGROUND AND OBJECTIVES: Sleepiness in patients with obstructive sleep apnea
(OSA) is associated with accidental and economic burden, as well as
cardiovascular risk. Despite OSA treatment, 10-28 % of patients report residual
sleepiness. Its determinants, as well as those of objective impaired alertness
remain poorly known. In this study, we investigated factors associated with
residual subjective sleepiness and objective impaired alertness in patients
treated for OSA.
METHODS: Consecutive OSA treated patients referred for maintenance of
wakefulness tests (MWT) at a tertiary university center were recruited between
2017 and 2020. Clinical data and polysomnography parameters were compared
between patients with vs without subjective sleepiness (Epworth Sleepiness
Scale, ESS≥11) and those with vs without impaired alertness (at least one trial
with sleep onset on MWT). A multivariate logistic model was used to assess
explanatory variables of MWT and ESS results.
RESULTS: We included 141 patients, of whom 12.8 % had both subjective sleepiness
and objective impaired alertness, 17.7 % objective impaired alertness only and
9.2 % subjective sleepiness only. Self-reported history of car accident/near
miss, smoking history and ESS≥11 were significantly associated with objective
impaired alertness whereas residual Apnea-hypopnea Index and CPAP use were not.
The only significant variable associated with ESS at the time of MWT evaluation
was initial ESS. Patients with objective impaired alertness only were more often
smokers (52 % vs 19 %, p = 0.01), had a higher body mass index (BMI) (32 vs
29 kg/m2, p = 0.05), and showed lower initial ESS (11 vs 13, p