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Correlation of sleep microstructure with daytime sleepiness and cognitive function in young and middle-aged adults with obstructive sleep apnea syndrome

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Abstract

Purpose

To compare microstructural features of sleep in young and middle-aged adults with differing severities of obstructive sleep apnea syndrome (OSAS), and to investigate the relationship between sleep microstructural fragmentation and cognitive impairment, as well as daytime sleepiness, in these patients.

Methods

A total of 134 adults with snoring (mean age, 37.54 ± 7.66 years) were classified into four groups based on apnea–hypopnea index: primary snoring, mild OSAS, moderate OSAS, and severe OSAS. Overnight polysomnography was performed to assess respiratory, sleep macrostructure (N1, N2, N3, and R), and sleep microstructure (arousal, cyclic alternating pattern [CAP]) parameters. Cognitive function and daytime sleepiness were assessed using Montreal Cognitive Assessment (MoCA) and Epworth Sleepiness Scale (ESS).

Results

As OSAS severity increased, MoCA gradually decreased and ESS gradually increased. N1%, N2%, and N3% sleep were significantly different between the severe OSAS group and the primary snoring, mild OSAS, and moderate OSAS groups (all P < 0.05). Overall arousal index, respiratory-related arousal index, CAP time, CAP rate, phase A index, number of CAP cycles, and phase A average time differed significantly in the moderate and severe OSAS groups compared with the mild OSAS and primary snoring groups (all P < 0.05). The strongest correlations identified by stepwise multiple regression analysis were between phase A3 index and the MoCA and ESS scores.

Conclusions

Sleep microstructure exhibited significant fragmentation in patients with moderate and severe OSAS, which was associated with decreased MoCA and increased ESS scores. This suggests that phase A3 index is a sensitive indicator of sleep fragmentation in OSAS.

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Funding

This study was funded by the Natural Science Foundation of China (Grant number: NSFC81770085) and the Suzhou Clinical Key Disease Diagnosis and Treatment Technology Special (Grant number: LCZX201604).

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Authors and Affiliations

  1. Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China

    Ningzhen Li, Jing Wang, Delu Wang, Qiaojun Wang, Fei Han, Krupakar Jyothi & Rui Chen

  2. Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China

    Ningzhen Li, Jing Wang, Delu Wang, Krupakar Jyothi & Rui Chen

  3. Department of Neurology, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China

    Qiaojun Wang & Fei Han

Authors
  1. Ningzhen Li
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  2. Jing Wang
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  3. Delu Wang
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  4. Qiaojun Wang
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  5. Fei Han
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  6. Krupakar Jyothi
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  7. Rui Chen
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Corresponding author

Correspondence to Rui Chen.

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Conflict of interest

Author Chen Rui has received research grants from the Natural Science Foundation of China and the Suzhou Clinical Key Disease Diagnosis and Treatment Technology Special. Author Chen Rui declares that she has no conflict of interest.

Ethical approval

The study was approved by our hospital’s institutional ethics committee (Batch number: JD-LK-2018-006-01).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on sleep apnea syndrome Guest Editors: Manuele Casale, Rinaldi Vittorio.

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Li, N., Wang, J., Wang, D. et al. Correlation of sleep microstructure with daytime sleepiness and cognitive function in young and middle-aged adults with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 276, 3525–3532 (2019). https://doi.org/10.1007/s00405-019-05529-y

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  • DOI: https://doi.org/10.1007/s00405-019-05529-y

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