Skip to main content
SpringerLink
Log in

Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to evaluate the prevalence and assess the response to nasal automatic positive airway pressure (APAP) therapy of less typical symptoms in patients diagnosed with obstructive sleep apnea (OSA), like fatigue, gasping, nocturia, nocturnal sweating, morning headaches, heartburn, and erectile dysfunction.

Methods

Ninety-eight male patients with moderate to severe OSA were included in the study (n = 98). In the beginning of the study, an overnight sleep study was performed to all subjects using a five-channel recording device. Patients started APAP therapy with pre-determined minimum and maximum pressures of 4 and 15 cmH20, respectively. The total Sleep Disorders Questionnaire was answered by all subjects before and 6 months after APAP therapy. Questions 4, 18, 23, 25, 58, 88, and 148 were used in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 17.0 software.

Results

Subjects had a mean (SD) age of 55.1 (10.8) years and an average of 52.2 (21.4) apnea–hypopnea events per hour of sleep. At baseline, nocturia was the most prevalent symptom (38%), followed by nocturnal sweating (34%), gasping (30%), erectile dysfunction (25%), fatigue (23%), heartburn (15%), and morning headaches (10%). After 6 months of APAP therapy, a statistically significant reduction on the prevalence of all symptoms was observed, except for erectile dysfunction and morning headaches.

Conclusion

The findings suggest that APAP therapy is effective in controlling the majority of OSA symptoms beyond sleepiness and snoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ram S, Seirawan H, Kumar SK, Clark GT (2010) Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath 14:63–70

    Article  PubMed  Google Scholar 

  2. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A (1998) Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 157:144–148

    PubMed  CAS  Google Scholar 

  3. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A (2001) Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163:608–613

    PubMed  CAS  Google Scholar 

  4. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  5. Durán J, Esnaola S, Rubio R, Iztueta A (2001) Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 163:685–689

    PubMed  Google Scholar 

  6. Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ (1996) Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest 109:1470–1476

    Article  PubMed  CAS  Google Scholar 

  7. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (2003) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 163:565–571

    Article  PubMed  Google Scholar 

  8. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

    PubMed  Google Scholar 

  9. Ayas NT, FitzGerald JM, Fleetham JA, White DP, Schulzer M, Ryan CF, Ghaeli R, Mercer GW, Cooper P, Tan MC, Marra CA (2006) Cost-effectiveness of continuous positive airway pressure therapy for moderate to severe obstructive sleep apnea/hypopnea. Arch Intern Med 166:977–984

    Article  PubMed  Google Scholar 

  10. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  11. Fuchs FS, Wiest GH, Frank M, Harsch IA, Schahin SP, Hahn EG, Ficker JH (2002) Auto-CPAP therapy for obstructive sleep apnea: induction of microarousals by automatic variations of CPAP pressure? Sleep 25:514–518

    PubMed  Google Scholar 

  12. Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, Gordon N, Douglas NJ (2003) Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 167:20–23

    Article  PubMed  Google Scholar 

  13. Teschler H, Wessendorf TE, Farhat AA, Konietzko N, Berthon-Jones M (2000) Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J 15:990–995

    Article  PubMed  CAS  Google Scholar 

  14. Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Rühle KH (2001) Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 163:652–657

    PubMed  CAS  Google Scholar 

  15. Galetke W, Anduleit N, Richter K, Stieglitz S, Randerath WJ (2008) Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study. Respiration 75:163–169

    Article  PubMed  Google Scholar 

  16. Mulgrew AT, Cheema R, Fleetham J, Ryan CF, Ayas NT (2007) Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial. Sleep Breath 11:31–37

    Article  PubMed  CAS  Google Scholar 

  17. Chotinaiwattarakul W, O'Brien LM, Fan L, Chervin RD (2009) Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med 5:222–227

    PubMed  Google Scholar 

  18. Chervin RD (2000) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 118:372–379

    Article  PubMed  CAS  Google Scholar 

  19. Engleman HM, Martin SE, Deary IJ, Douglas NJ (1997) Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 52:114–119

    Article  PubMed  CAS  Google Scholar 

  20. Moriyama Y, Miwa K, Tanaka H, Fujihiro S, Nishino Y, Deguchi T (2008) Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome. Urology 71:1096–1098

    Article  PubMed  Google Scholar 

  21. Peltier AC, Consens FB, Sheikh K, Wang L, Song Y, Russell JW (2007) Autonomic dysfunction in obstructive sleep apnea is associated with impaired glucose regulation. Sleep Med 8:149–155

    Article  PubMed  Google Scholar 

  22. Woodson BT, Brusky LT, Saurajen A, Jaradeh S (2004) Association of autonomic dysfunction and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 130:643–648

    Article  PubMed  Google Scholar 

  23. Ulfberg J, Carter N, Talbäck M, Edling C (1996) Headache, snoring and sleep apnoea. J Neurol 243:621–625

    Article  PubMed  CAS  Google Scholar 

  24. Alberti A, Mazzotta G, Gallinella E, Sarchielli P (2005) Headache characteristics in obstructive sleep apnea syndrome and insomnia. Acta Neurol Scand 111:309–316

    Article  PubMed  CAS  Google Scholar 

  25. Loh NK, Dinner DS, Foldvary N, Skobieranda F, Yew WW (1999) Do patients with obstructive sleep apnea wake up with headaches? Arch Intern Med 159:1765–1768

    Article  PubMed  CAS  Google Scholar 

  26. Provini F, Vetrugno R, Lugaresi E, Montagna P (2006) Sleep-related breathing disorders and headache. Neurol Sci 27:S149–S152

    Article  PubMed  Google Scholar 

  27. Demeter P, Pap A (2004) The relationship between gastroesophageal reflux disease and obstructive sleep apnea. J Gastroenterol 39:815–820

    Article  PubMed  Google Scholar 

  28. Guda N, Partington S, Vakil N (2004) Symptomatic gastro-oesophageal reflux, arousals and sleep quality in patients undergoing polysomnography for possible obstructive sleep apnoea. Aliment Pharmacol Ther 20:1153–1159

    Article  PubMed  CAS  Google Scholar 

  29. Green BT, Broughton WA, O'Connor JB (2003) Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Arch Intern Med 163:41–45

    Article  PubMed  Google Scholar 

  30. Kerr P, Shoenut JP, Millar T, Buckle P, Kryger MH (1992) Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest 101:1539–1544

    Article  PubMed  CAS  Google Scholar 

  31. Tawk M, Goodrich S, Kinasewitz G, Orr W (2006) The effect of 1 week of continuous positive airway pressure treatment in obstructive sleep apnea patients with concomitant gastroesophageal reflux. Chest 130:1003–1008

    Article  PubMed  Google Scholar 

  32. Margel D, Cohen M, Livne PM, Pillar G (2004) Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 63:545–549

    Article  PubMed  Google Scholar 

  33. Margel D, Tal R, Livne PM, Pillar G (2005) Predictors of erectile function improvement in obstructive sleep apnea patients with long-term CPAP treatment. Int J Impot Res 17:186–190

    Article  PubMed  CAS  Google Scholar 

  34. Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, de Bont LG (2007) Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 4:1153–1162

    Article  PubMed  Google Scholar 

  35. Margel D, Shochat T, Getzler O, Livne PM, Pillar G (2006) Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology 67:974–977

    Article  PubMed  Google Scholar 

  36. Silva GE, An MW, Goodwin JL, Shahar E, Redline S, Resnick H, Baldwin CM, Quan SF (2009) Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 32:1049–1057

    PubMed  Google Scholar 

  37. Kiely JL, Murphy M, McNicholas WT (1999) Subjective efficacy of nasal CPAP therapy in obstructive sleep apnoea syndrome: a prospective controlled study. Eur Respir J 13:1086–1090

    Article  PubMed  CAS  Google Scholar 

  38. <!-- 38. (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 22:667–689 -->

  39. Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, Guilleminault C, Dement WC (1994) The sleep disorders questionnaire: I: creation and multivariate structure of SDQ. Sleep 17:160–167

    PubMed  CAS  Google Scholar 

  40. Zias N, Bezwada V, Gilman S, Chroneou A (2009) Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor? Sleep Breath 13:3–10

    Article  PubMed  Google Scholar 

  41. Perimenis P, Karkoulias K, Markou S, Gyftopoulos K, Athanasopoulos A, Barbalias G, Kiriazopoulou V, Spiropoulos K (2004) Erectile dysfunction in men with obstructive sleep apnea syndrome: a randomized study of the efficacy of sildenafil and continuous positive airway pressure. Int J Impot Res 16:256–260

    Article  PubMed  CAS  Google Scholar 

  42. Perimenis P, Konstantinopoulos A, Karkoulias K, Markou S, Perimeni P, Spyropoulos K (2007) Sildenafil combined with continuous positive airway pressure for treatment of erectile dysfunction in men with obstructive sleep apnea. Int Urol Nephrol 39:547–552

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the contribution of Armando Teixeira-Pinto (Serviço de Bioestatística e Informática Médica, CINTESIS, Faculty of Medicine, University of Porto) and Joselina Maria Pinto Barbosa (Centro de Educação Médica, Faculty of Medicine, University of Porto) to the statistical analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pulmonology, São João Hospital, Faculty of Medicine, University of Porto, Alameda Professor Doutor Hernâni Monteiro, 4200–319, Porto, Portugal

    Ivo A. C. Cruz, Marta Drummond & João C. Winck

Authors
  1. Ivo A. C. Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marta Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. João C. Winck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to João C. Winck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cruz, I.A.C., Drummond, M. & Winck, J.C. Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep Breath 16, 361–366 (2012). https://doi.org/10.1007/s11325-011-0502-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0502-4

Keywords

Search

Navigation