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Daytime sleepiness in patients with obstructive sleep apnea and severe obesity: prevalence, predictors, and therapy

Tagesschläfrigkeit bei Patienten mit obstruktiver Schlafapnoe und ausgeprägter Adipositas: Prävalenz, Prädiktoren und Therapie

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Summary

Background

We sought to determine prevalence and predictors of excessive daytime sleepiness in patients with severe obesity with a body mass index (BMI) > 35 kg/m2 and obstructive sleep apnea (OSA) with an apnea-hypopnea index > 15/h.

Methods

The study population consisted of 245 obese OSA patients with a BMI > 35 kg/m2, who were retrospectively recruited from 3256 consecutive patients who underwent polysomnography at our sleep laboratory between 2006 and 2009. Baseline clinical characteristics and polysomnography results of these 245 patients were compared between patients with and without excessive daytime sleepiness, which was diagnosed in the presence of an Epworth Sleepiness Scale score (ESS) ≥ 11.

Results

A total of 123 of 245 study patients (50.2 %) had an ESS ≥ 11. Patients with an ESS ≥ 11 were younger and less often unemployed or retired compared with patients with an ESS < 11. Polysomnography revealed a longer total sleep time (TST), higher sleep efficiency, and shorter sleep latency in patients with ESS ≥ 11. In addition, obstructive apneas during TST as well as oxygen saturations < 80 % occurred significantly more often in patients with versus without an ESS ≥ 11. Improvement of daytime sleepiness after initiation of continuous positive airway pressure (CPAP) therapy occurred more often in patients with versus without ESS ≥ 11 (93 versus 73 %, p < 0.01).

Conclusion

Obese patients with OSA and excessive daytime sleepiness are characterized by younger age, longer TSTs, more frequent obstructive apneas, and oxygen desaturations < 80 % compared with patients without excessive daytime sleepiness. Excessive daytime sleepiness can be improved in more than 90 % of patients using CPAP therapy.

Zusammenfassung

Grundlagen

Wir untersuchten Prävalenz und Prädiktoren exzessiver Tagesschläfrigkeit bei Patienten mit ausgeprägter Adipositas mit einem Body Mass Index (BMI) > 35 kg/m2 und obstruktiver Schlafapnoe (OSA) mit einem Apnoe-Hypopnoe Index (AHI) > 15/h.

Methodik

Das Untersuchungskollektiv bestand aus 245 adipösen Patienten mit OSA und einem BMI ≥ 35 kg/m2, die retrospektiv aus 3256 konsekutiven Patienten rekrutiert wurden und sich von 2006 bis 2009 zur Polysomnographie im schlafmedizinischen Zentrum vorstellten. Die Charakteristika dieser 245 Patienten sowie die Ergebnisse der Polysomnographie wurden verglichen zwischen Patienten mit und ohne ausgeprägter Tagesschläfrigkeit, welche mit dem Epworth Sleepiness Scale Score (ESS) ≥ 11 diagnostiziert wurde.

Ergebnisse

Bei 123 der 245 Patienten (50,2 %) lag der ESS-Score bei ≥ 11. Patienten mit ESS ≥ 11 waren jünger und seltener arbeitslos oder berentet, verglichen mit Patienten mit ESS < 11. Bei der Polysomnographie zeigten Patienten mit ESS ≥ 11 eine erhöhte Schlafdauer (TST), eine höhere Schlafeffizienz und eine kürzere Schlaflatenz. Außerdem hatten Patienten mit ESS ≥ 11 signifikant häufiger obstruktive Apnoephasen und Sauerstoffent­sättigungen < 80 % verglichen mit Patienten mit ESS < 11. Eine Verbesserung der Tagesmüdigkeit nach Einleitung einer CPAP Therapie zeigte sich häufiger bei Patienten mit versus ohne ESS ≥ 11 (93 versus 73 %, p < 0.01).

Schlussfolgerung

Adipöse Patienten mit OSA und exzessiver Tagesschläfrigkeit sind jünger und haben eine erhöhte Schlafdauer mit häufigeren obstruktiven Apnoen und Sauerstoffentsättigungen < 80 % verglichen mit Patienten ohne exzessiver Tagesschläfrigkeit. Die exzessive Tagesschläfrigkeit kann mit CPAP Therapie bei über 90 % der Patienten gebessert werden.

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Authors and Affiliations

  1. Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany

    Ulrich Koehler MD, Catharina Buchholz MD, Werner Cassel MSc, Olaf Hildebrandt MSc, Felicitas Redhardt MD, Janine Töpel BSc & Christoph Nell MSc

  2. Department of Mathematics, Natural Sciences and Informatics, Technische Hochschule Mittelhessen, Giessen, Germany

    Keywan Sohrabi PhD

  3. Department of Cardiology, University Hospital of Marburg and Gießen, Marburg, Germany

    Wolfram Grimm MD

  4. Department of Pneumology and Sleep Medicine, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany

    Ulrich Koehler MD

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  1. Ulrich Koehler MD
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  2. Catharina Buchholz MD
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Correspondence to Ulrich Koehler MD.

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Koehler, U., Buchholz, C., Cassel, W. et al. Daytime sleepiness in patients with obstructive sleep apnea and severe obesity: prevalence, predictors, and therapy. Wien Klin Wochenschr 126, 619–625 (2014). https://doi.org/10.1007/s00508-014-0591-8

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  • DOI: https://doi.org/10.1007/s00508-014-0591-8

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