Chest
Volume 125, Issue 6, June 2004, Pages 2091-2096
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Clinical Investigations
Sleep and Breathing
Obstructive Sleep Apnea Syndrome, Sleepiness, and Quality of Life

https://doi.org/10.1378/chest.125.6.2091Get rights and content

Objective

To evaluate the addition of short arousals of > 3 s on indexes of sleep-disordered breathing (SDB) and subjective sleepiness in patients with obstructive sleep apnea (OSA), and to evaluate the quality of life and reported difficulty driving with arousal index and indexes of SDB.

Method

Data was collected from a general clinical evaluation, and evaluations using the Epworth sleepiness scale (ESS), the sleep disorders questionnaire, the Beck depression inventory (BDI), the Medical Outcomes Study 36-item short form health survey (SF-36), a questionnaire on driving difficulties and accidents, and polysomnography.

Results

A total of 135 male subjects (mean [± SD] age, 52 ± 12.1 years; mean body mass index [BMI], 27.8 ± 5.6 kg/m2; mean apnea-hypopnea index [AHI], 48.7 ± 26.8 events per hour) were studied. Of these subjects, 70.4% acknowledged having driven while sleepy. ESS scores correlated significantly with the arousal index and AHI, and negatively with the lowest arterial oxygen saturation. The “physical functioning,” “general health,” and “role physical” subscales of the SF-36 correlated with the arousal index. No significant correlation was seen in multiple regression analyses after adjusting for age and BMI, using “reports of sleepiness while driving” as the dependent variable.

Conclusion

Several subjective complaints and subscales of the SF-36 correlated significantly with a frequency of SDB-related arousal of > 3 s. Patients perceived that an organic health problem had been impairing their quality of life more than an emotional problem, despite elevated scores on the BDI. However, if sleepiness while driving was common in OSA patients, it was not significant. Many clinical and polysomnographic variables may be considered as possible independent variables in the regression analysis. Other unrelated factors have a greater impact. To relate sleepiness while driving only to the usually studied variables in OSA patients is an oversimplification.

Section snippets

Subjects

During a 12-month period, male subjects between 20 and 65 years of age, who had been referred for snoring, fatigue, and/or daytime sleepiness, underwent a standardized prospective protocol that included a general clinical evaluation, and evaluations by a sleep specialist and psychiatrist.

Subjects who had experienced chronic psychiatric disorders, alcoholism, drug abuse, intake of psychotropic medications (including hypnotic and stimulant agents), unstable medical regimens, circadian rhythm

Subjects

The study included 135 male subjects. The mean (± SD) age was 52 ± 12.1 years, the mean body mass index (BMI) was 27.8 ± 5.6 kg/m2, the mean AHI was 48.7 ± 26.8 events per h, the mean BDI was 8.0 ± 5.9, 60 subjects (44.4%) reported symptoms of esophageal reflux, 62 subjects (45.9%) reported more than one nightly episode of nocturia, and 25 patients (18.5%) received antihypertensive medication. All subjects had a drivers license and drove at least weekly. Twenty-five subjects (18.5%) reported

ACKNOWLEDGMENT

We thank Stephen Brooks, MD, for his editing of the manuscript.

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This work was part of a thesis by Dr. Gonsalves fulfilling the requirements for a Masters degree in Mental Health from the Sleep Research Center of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Dr. Guilleminault was the recipient of an academic award from the Sleep Research Center, the National Heart, Lung, and Blood Institute, the National Institutes of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

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