The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep

Research output: Contribution to journalArticle

Abstract

Background: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. Study Objectives: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). Design: Cross-sectional study. Setting: University-based sleep disorders laboratory. Participants: Patients referred for polysomnography and daytime MSLT (n=1,821). Interventions: N/A Measurements and Results: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI <8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. Conclusion: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.

Original languageEnglish (US)
Pages (from-to)307-314
Number of pages8
JournalSleep
Volume25
Issue number3
StatePublished - May 1 2002

Fingerprint

REM Sleep
Sleep Apnea Syndromes
Eye Movements
Sleep
Apnea
Polysomnography
Kaplan-Meier Estimate
Respiration
Body Mass Index
Cross-Sectional Studies

Keywords

  • Daytime sleepiness
  • Multiple sleep latency test
  • Non-rapid eye movement sleep
  • Rapid eye movement sleep
  • Sleep apnea
  • Sleep-disordered breathing
  • Survival analysis

ASJC Scopus subject areas

  • Physiology

Cite this

@article{9f7dbc7c26784c6994db1bc00d96b4a6,
title = "The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep",
abstract = "Background: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. Study Objectives: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). Design: Cross-sectional study. Setting: University-based sleep disorders laboratory. Participants: Patients referred for polysomnography and daytime MSLT (n=1,821). Interventions: N/A Measurements and Results: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI <8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95{\%}CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95{\%}CI: 1.01-1.46), 1.20 (95{\%}CI: 1.05-1.37), and 1.10 (95{\%}CI: 1.04-1.16), respectively. Conclusion: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.",
keywords = "Daytime sleepiness, Multiple sleep latency test, Non-rapid eye movement sleep, Rapid eye movement sleep, Sleep apnea, Sleep-disordered breathing, Survival analysis",
author = "Punjabi, {Naresh M} and {Bandeen Roche}, {Karen J} and Marx, {Jason J.} and David Neubauer and Smith, {Philip L} and Schwartz, {Alan R}",
year = "2002",
month = "5",
day = "1",
language = "English (US)",
volume = "25",
pages = "307--314",
journal = "Sleep",
issn = "0161-8105",
publisher = "American Academy of Sleep Medicine",
number = "3",

}

TY - JOUR

T1 - The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep

AU - Punjabi, Naresh M

AU - Bandeen Roche, Karen J

AU - Marx, Jason J.

AU - Neubauer, David

AU - Smith, Philip L

AU - Schwartz, Alan R

PY - 2002/5/1

Y1 - 2002/5/1

N2 - Background: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. Study Objectives: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). Design: Cross-sectional study. Setting: University-based sleep disorders laboratory. Participants: Patients referred for polysomnography and daytime MSLT (n=1,821). Interventions: N/A Measurements and Results: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI <8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. Conclusion: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.

AB - Background: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. Study Objectives: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). Design: Cross-sectional study. Setting: University-based sleep disorders laboratory. Participants: Patients referred for polysomnography and daytime MSLT (n=1,821). Interventions: N/A Measurements and Results: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI <8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. Conclusion: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.

KW - Daytime sleepiness

KW - Multiple sleep latency test

KW - Non-rapid eye movement sleep

KW - Rapid eye movement sleep

KW - Sleep apnea

KW - Sleep-disordered breathing

KW - Survival analysis

UR - http://www.scopus.com/inward/record.url?scp=0036570675&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036570675&partnerID=8YFLogxK

M3 - Article

C2 - 12003161

AN - SCOPUS:0036570675

VL - 25

SP - 307

EP - 314

JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 3

ER -