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Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea

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Abstract

Purpose

Isolated sleep paralysis (ISP) is a rapid eye movement (REM) sleep parasomnia and has a special meaning in Chinese population. Worsening of obstructive sleep apnea (OSA) occurs especially during REM sleep. The relationship between ISP and OSA is unclear. The aim of this study was to investigate the impact of ISP on sleep and life quality in Chinese-Taiwanese OSA patients.

Methods

We recruited 107 OSA patients diagnosed by polysomnography (PSG) in Southern Taiwan. ISP was evaluated by self-reported sleep questionnaire. We used Chinese version of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Short-Form 36 (SF36) to evaluate daytime sleepiness, nocturnal sleep quality, and health-related quality of life, respectively for OSA patients. Student’s t-test was used to compare PSG parameters, ESS, PSQI, physical and mental component of SF-36 (P-SF36 and M-SF36) between OSA patients with and without ISP. Stepwise multiple regression was used to find out the factors independently associated with ESS, PSQI, P-SF36, and M-SF36.

Results

Forty-one of 107 patients (38.3%) had ISP. It showed no significant difference in PSG parameters between OSA patients with and without ISP. OSA patients with ISP had significantly higher ESS (P = 0.010), higher PSQI (P = 0.007), lower P-SF36 (P = 0.020), and lower M-SF36 (P = 0.001) than those without ISP. ISP was an independent factor associated with ESS (P = 0.017), PSQI (P = 0.001), and M-SF36 (P = 0.030) after adjusting for other confounding variables.

Conclusions

ISP was independently associated with excessive daytime sleepiness, worse sleep quality, and impaired mental health-related quality of life in Chinese-Taiwanese OSA patients.

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Abbreviations

AHI:

Apnea-hypopnea index

ArI:

Arousal index

BMI:

Body mass index

ESS:

Epworth Sleepiness Scale

ISP:

Isolated sleep paralysis

M-SF36:

Mental component of SF-36

OSA:

Obstructive sleep apnea

P-SF36:

Physical component of SF-36

PSG:

Polysomnography

PSQI:

Pittsburgh sleep quality index

REM:

Rapid eye movement

SF36:

Short-form 36

SpO2:

Average pulse oxyhemoglobin saturation

References

  1. American Academy of Sleep Medicine. (2005). The international classification of sleep disorders, diagnostic and coding manual (2nd ed.). Westchester, IL: American Academy of Sleep Medicine.

    Google Scholar 

  2. Ramsawh, H. J., Raffa, S. D., White, K. S., & Barlow, D. H. (2008). Risk factors for isolated sleep paralysis in an African American sample: A preliminary study. Behavior Therapy, 39(4), 386–397.

    Article  PubMed  Google Scholar 

  3. Takeuchi, T., Miyasita, A., Sasaki, Y., Inugami, M., & Fukuda, K. (1992). Isolated sleep paralysis elicited by sleep interruption. Sleep, 15(3), 217–225.

    CAS  PubMed  Google Scholar 

  4. Smith, P. M., Brown, D., & Mellman, T. A. (2008). Sleep paralysis and sleep duration. Journal of the National Medical Association, 100(10), 1207–1208.

    PubMed  Google Scholar 

  5. Bell, C. C., Dixie-Bell, D. D., & Thompson, B. (1986). Panic attacks: Relationship to isolated sleep paralysis. The American Journal of Psychiatry, 143(11), 1484.

    CAS  PubMed  Google Scholar 

  6. Otto, M. W., Simon, N. M., Powers, M., Hinton, D., Zalta, A. K., & Pollack, M. H. (2006). Rates of isolated sleep paralysis in outpatients with anxiety disorders. Journal of Anxiety Disorders, 20(5), 687–693.

    Article  PubMed  Google Scholar 

  7. Hinton, D. E., Pich, V., Chhean, D., Pollack, M., & McNally, R. J. (2005). Sleep paralysis among Cambodian refugees: Association with PTSD diagnosis and severity. Depression and Anxiety, 22(2), 47–51.

    Article  PubMed  Google Scholar 

  8. Findley, L. J., Wilhoit, S. C., & Suratt, P. M. (1985). Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest, 87(4), 432–436.

    Article  CAS  PubMed  Google Scholar 

  9. Horner, R. L. (2008). Pathophysiology of obstructive sleep apnea. Journal of Cardiopulmonary Rehabilitation and Prevention, 28(5), 289–298.

    PubMed  Google Scholar 

  10. Iranzo, A., & Santamaria, J. (2005). Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep, 28(2), 203–206.

    PubMed  Google Scholar 

  11. Somers, V. K., Dyken, M. E., Clary, M. P., & Abboud, F. M. (1995). Sympathetic neural mechanisms in obstructive sleep apnea. The Journal of Clinical Investigation, 96(4), 1897–1904.

    Article  CAS  PubMed  Google Scholar 

  12. De Jong, J. T. (2005). Cultural variation in the clinical presentation of sleep paralysis. Transcultural Psychiatry, 42(1), 78–92.

    Article  PubMed  Google Scholar 

  13. Jiménez-Genchi, A., Avila-Rodríguez, V. M., Sánchez-Rojas, F., Terrez, B. E., & Nenclares-Portocarrero, A. (2009). Sleep paralysis in adolescents: The ‘a dead body climbed on top of me’ phenomenon in Mexico. Psychiatry and Clinical Neurosciences, 63(4), 546–549.

    Article  PubMed  Google Scholar 

  14. Kompanje, E. J. (2008). ‘The devil lay upon her and held her down’. Hypnagogic hallucinations and sleep paralysis described by the Dutch physician Isbrand van Diemerbroeck (1609–1674) in 1664. Journal of Sleep Research, 17(4), 464–467.

    Article  CAS  PubMed  Google Scholar 

  15. Wing, Y. K., Lee, S. T., & Chen, C. N. (1994). Sleep paralysis in Chinese: Ghost oppression phenomenon in Hong Kong. Sleep, 17(7), 609–613.

    CAS  PubMed  Google Scholar 

  16. Szklo-Coxe, M., Young, T., Finn, L., & Mignot, E. (2007). Depression: Relationships to sleep paralysis and other sleep disturbances in a community sample. Journal of Sleep Research, 16(3), 297–312.

    Article  PubMed  Google Scholar 

  17. Wing, Y. K., Chiu, H., Leung, T., & Ng, J. (1999). Sleep paralysis in the elderly. Journal of Sleep Research, 8(2), 151–155.

    Article  CAS  PubMed  Google Scholar 

  18. Al Lawati, N. M., Patel, S. R., & Ayas, N. T. (2009). Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Progress in Cardiovascular Diseases, 51(4), 285–293.

    Article  PubMed  Google Scholar 

  19. Baldwin, C. M., Griffith, K. A., Nieto, F. J., O’Connor, G. T., Walsleben, J. A., & Redline, S. (2001). The association of sleep-disordered breathing and sleep symptoms with quality of life in the sleep heart health study. Sleep, 24(1), 96–105.

    CAS  PubMed  Google Scholar 

  20. Young, T., Peppard, P. E., & Gottlieb, D. J. (2002). Epidemiology of obstructive sleep apnea: A population health perspective. American Journal of Respiratory and Critical Care Medicine, 165(9), 1217–1239.

    Article  PubMed  Google Scholar 

  21. Rechtschaffen, A., & Kales, A. (1968). A manual of standardized terminology, technique and scoring system from sleep stages of human subjects. Washington, DC: Public Health Service, Government Printing Office.

    Google Scholar 

  22. American Academy of Sleep Medicine Task Force. (1999). Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The report of an American academy of sleep medicine task force. Sleep, 22(5), 667–689.

    Google Scholar 

  23. Chen, N. H., Johns, M. W., Li, H. Y., Chu, C. C., Liang, S. C., Shu, Y. H., et al. (2002). Validation of a Chinese version of the Epworth sleepiness scale. Quality of Life Research, 11(8), 817–821.

    Article  PubMed  Google Scholar 

  24. Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., et al. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh sleep quality index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(80), 1943–1952.

    Article  CAS  PubMed  Google Scholar 

  25. Cheung, Y. B., Machin, D., Fong, K. Y., Thio, S. T., & Thumboo, J. (2005). Discriminative ability of the short-form 36 health survey: A tale of two versions. Quality of Life Research, 14(2), 555–559.

    Article  CAS  PubMed  Google Scholar 

  26. Sansa, G., Iranzo, A., & Santamaria, J. (2009). Obstructive sleep apnea in narcolepsy. Sleep Medicine. doi:10.1016/j.sleep.2009.02.009.

  27. Lavie, P., & Peled, R. (1987). Narcolepsy is a rare disease in Israel. Sleep, 10(6), 608–609.

    CAS  PubMed  Google Scholar 

  28. Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. The New England Journal of Medicine, 328(17), 1230–1235.

    Article  CAS  PubMed  Google Scholar 

  29. Wenner, J. B., Cheema, R., & Ayas, N. T. (2009). Clinical manifestations and consequences of obstructive sleep apnea. Journal of Cardiopulmonary Rehabilitation and Prevention, 29(2), 76–83.

    PubMed  Google Scholar 

  30. Rakel, R. E. (2009). Clinical and societal consequences of obstructive sleep apnea and excessive daytime sleepiness. Postgraduate Medicine, 121(1), 86–95.

    Article  PubMed  Google Scholar 

  31. Saunamäki, T., & Jehkonen, M. (2007). Depression and anxiety in obstructive sleep apnea syndrome: A review. Acta Neurologica Scandinavica, 116(5), 277–288.

    Article  PubMed  Google Scholar 

  32. Scheltens, P., Visscher, F., Van Keimpema, A. R., Lindeboom, J., Taphoorn, M. J., & Wolters, E. C. (1991). Sleep apnea syndrome presenting with cognitive impairment. Neurology, 41(1), 155–156.

    CAS  PubMed  Google Scholar 

  33. Gottlieb, D. J., Whitney, C. W., Bonekat, W. H., Iber, C., James, G. D., Lebowitz, M., et al. (1999). Relation of sleepiness to respiratory disturbance index: The sleep heart health study. American Journal of Respiratory and Critical Care Medicine, 159(2), 502–507.

    CAS  PubMed  Google Scholar 

  34. Veasey, S. C. (2006). Obstructive sleep apnea: Re-evaluating our index of severity. Sleep Medicine, 7(1), 5–6.

    Article  PubMed  Google Scholar 

  35. Feige, B., Al-Shajlawi, A., Nissen, C., Voderholzer, U., Hornyak, M., Spiegelhalder, K., et al. (2008). Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients. Journal of Sleep Research, 17(2), 180–190.

    Article  PubMed  Google Scholar 

  36. Martin, S. E., Wraith, P. K., Deary, I. J., & Douglas, N. J. (1997). The effect of nonvisible sleep fragmentation on daytime function. American Journal of Respiratory and Critical Care Medicine, 155(5), 1596–1601.

    CAS  PubMed  Google Scholar 

  37. Cheyne, J. A., Newby-Clark, I. R., & Rueffer, S. D. (1999). Relations among hypnagogic and hypnopompic experiences associated with sleep paralysis. Journal of Sleep Research, 8(4), 313–317.

    Article  CAS  PubMed  Google Scholar 

  38. Lee, Y. J. (1995). Sleep disorders in Chinese culture: Experiences from a study of insomnia in Taiwan. Psychiatry and Clinical Neurosciences, 49(2), 103–106.

    Article  CAS  PubMed  Google Scholar 

  39. Verma, A., Radtke, R. A., VanLandingham, K. E., King, J. H., & Husain, A. M. (2001). Slow wave sleep rebound and REM rebound following the first night of treatment with CPAP for sleep apnea: Correlation with subjective improvement in sleep quality. Sleep Medicine, 2(3), 215–223.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully appreciated Miss Yen-Ju Chuang, Fu-Huei Tsai, and Huei-En Cheng in the sleep center of Kaohsiung Medical University Hospital for their kindly assistance in data collection.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 80754, Taiwan

    Sun-Wung Hsieh, Chiou-Lian Lai, Ching-Kuan Liu, Sheng-Hsing Lan & Chung-Yao Hsu

  2. Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Sun-Wung Hsieh, Chiou-Lian Lai, Ching-Kuan Liu & Chung-Yao Hsu

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  1. Sun-Wung Hsieh
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  2. Chiou-Lian Lai
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Correspondence to Chung-Yao Hsu.

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Hsieh, SW., Lai, CL., Liu, CK. et al. Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea. Qual Life Res 19, 1265–1272 (2010). https://doi.org/10.1007/s11136-010-9695-4

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