J Rhinol.  2024 Jul;31(2):86-92. 10.18787/jr.2024.00014.

Prognostic Factors Related to Sleep Quality in Patients With Obstructive Sleep Apnea After Positive Airway Pressure Therapy

• Park DH
• Choi H
• Nam K
• Lee SH
• Seo MY

• KMID: 2558234
• DOI: http://doi.org/10.18787/jr.2024.00014

Abstract

Background and Objectives
This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy.
Methods
In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment.
Results
Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m²) than in the persistent EDS group (27.13 kg/m²; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p<0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p<0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p<0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p<0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p<0.001) and multivariate (OR=0.973, p=0.019) analyses.
Conclusion
Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient’s self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.

Keyword

Sleep apnea; Obstructive; Continuous positive airway pressure; Sleep quality

Reference

References

1. Phillips BG, Narkiewicz K, Pesek CA, Haynes WG, Dyken ME, Somers VK. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens. 1999; 17(1):61–6.

2. Seo MY, Hwang SJ, Nam KJ, Lee SH. Significance of sleep stability using cardiopulmonary coupling in sleep disordered breathing. Laryngoscope. 2020; 130(8):2069–75.

3. Fattinger S, de Beukelaar TT, Ruddy KL, Volk C, Heyse NC, Herbst JA, et al. Deep sleep maintains learning efficiency of the human brain. Nat Commun. 2017; 8:15405.

4. Bonsignore MR, Pepin JL, Cibella F, Barbera CD, Marrone O, Verbraecken J, et al. Excessive daytime sleepiness in obstructive sleep apnea patients treated with continuous positive airway pressure: data from the European Sleep Apnea Database. Front Neurol. 2021; 12:690008.

5. Seo MY, Lee MK, Han MS, Yoo J, Lee SH. Improvement of morning headache in adults with obstructive sleep apnea after positive airway pressure therapy. Sci Rep. 2023; 13(1):14620.

6. Stepnowsky C, Zamora T, Edwards C. Does positive airway pressure therapy result in improved sleep quality? Health (Irvine Calif). 2014; 6(18):2416–24.

7. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012; 8(5):597–619.

8. Weaver TE, Maislin G, Dinges DF, Younger J, Cantor C, McCloskey S, et al. Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep. 2003; 26(6):727–32.

9. Ratnavadivel R, Chau N, Stadler D, Yeo A, McEvoy RD, Catcheside PG. Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med. 2009; 5(6):519–24.

10. Javaheri S, Javaheri S. Update on persistent excessive daytime sleepiness in OSA. Chest. 2020; 158(2):776–86.

11. Lal C, Weaver TE, Bae CJ, Strohl KP. Excessive daytime sleepiness in obstructive sleep apnea. Mechanisms and clinical management. Ann Am Thorac Soc. 2021; 18(5):757–68.

12. Goksan B, Gunduz A, Karadeniz D, Ağan K, Tascilar FN, Tan F, et al. Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure. Cephalalgia. 2009; 29(6):635–41.

13. Ohayon MM. Prevalence and risk factors of morning headaches in the general population. Arch Intern Med. 2004; 164(1):97–102.

14. Kristiansen HA, Kværner KJ, Akre H, Øverland B, Sandvik L, Russell MB. Sleep apnoea headache in the general population. Cephalalgia. 2012; 32(6):451–8.

15. Sand T, Hagen K, Schrader H. Sleep apnoea and chronic headache. Cephalalgia. 2003; 23(2):90–5.

16. Lovati C, Zardoni M, D’Amico D, Pecis M, Giani L, Raimondi E, et al. Possible relationships between headache–allodynia and nocturnal sleep breathing. Neurol Sci. 2011; 32(Suppl 1):S145–8.