Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea: Results from the international Sleep Apnea Global Interdisciplinary Consortium (SAGIC)

Abstract

Abstract Study objectives Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among OSA patients. Methods Sleepiness was assessed using the Epworth Sleepiness Scale (>10 points defined as “risk of dozing”) and a measure of general sleepiness (feeling sleepy ≥3 times/week defined as “feeling sleepy”). Four sleepiness phenotypes were identified: “non-sleepy”, “risk of dozing only”, “feeling sleepy only” and “both at risk of dozing and feeling sleepy”. Results Altogether, 2083 OSA patients (69% male) with an apnea-hypopnea index (AHI) ≥5 events/hour were studied; 46% were “non-sleepy”, 26% at “risk of dozing only”, 7% were “feeling sleepy only” and 21% reported both. The two phenotypes at “risk of dozing” had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO2], time spent <90% SpO2, and hypoxic burden) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than “non-sleepy” and “feeling sleepy only” phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders. Conclusions In a large international group of OSA patients, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as “risk of dozing” or “non-sleepy”, while “feeling sleepy only” did not differ from “non-sleepy” individuals.