Sleep and Breathing

, Volume 16, Issue 2, pp 361–366

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

  • Ivo A. C. Cruz
  • Marta Drummond
  • João C. Winck
Original Article

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.

Keywords

Obstructive sleep apnea Automatic positive airway pressure Symptoms Prevalence Treatment 

References

  1. 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 14:63–70PubMedCrossRefGoogle Scholar
  2. 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 157:144–148PubMedGoogle Scholar
  3. 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 163:608–613PubMedGoogle Scholar
  4. 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 328:1230–1235PubMedCrossRefGoogle Scholar
  5. 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 163:685–689PubMedGoogle Scholar
  6. 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 109:1470–1476PubMedCrossRefGoogle Scholar
  7. 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 163:565–571PubMedCrossRefGoogle Scholar
  8. 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 5:263–276PubMedGoogle Scholar
  9. 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 166:977–984PubMedCrossRefGoogle Scholar
  10. 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 365:1046–1053PubMedGoogle Scholar
  11. 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 25:514–518PubMedGoogle Scholar
  12. 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 167:20–23PubMedCrossRefGoogle Scholar
  13. 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 15:990–995PubMedCrossRefGoogle Scholar
  14. 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 163:652–657PubMedGoogle Scholar
  15. 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 75:163–169PubMedCrossRefGoogle Scholar
  16. 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 11:31–37PubMedCrossRefGoogle Scholar
  17. 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 5:222–227PubMedGoogle Scholar
  18. 18.
    Chervin RD (2000) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 118:372–379PubMedCrossRefGoogle Scholar
  19. 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 52:114–119PubMedCrossRefGoogle Scholar
  20. 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 71:1096–1098PubMedCrossRefGoogle Scholar
  21. 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 8:149–155PubMedCrossRefGoogle Scholar
  22. 22.
    Woodson BT, Brusky LT, Saurajen A, Jaradeh S (2004) Association of autonomic dysfunction and mild obstructive sleep apnea. Otolaryngol Head Neck Surg 130:643–648PubMedCrossRefGoogle Scholar
  23. 23.
    Ulfberg J, Carter N, Talbäck M, Edling C (1996) Headache, snoring and sleep apnoea. J Neurol 243:621–625PubMedCrossRefGoogle Scholar
  24. 24.
    Alberti A, Mazzotta G, Gallinella E, Sarchielli P (2005) Headache characteristics in obstructive sleep apnea syndrome and insomnia. Acta Neurol Scand 111:309–316PubMedCrossRefGoogle Scholar
  25. 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 159:1765–1768PubMedCrossRefGoogle Scholar
  26. 26.
    Provini F, Vetrugno R, Lugaresi E, Montagna P (2006) Sleep-related breathing disorders and headache. Neurol Sci 27:S149–S152PubMedCrossRefGoogle Scholar
  27. 27.
    Demeter P, Pap A (2004) The relationship between gastroesophageal reflux disease and obstructive sleep apnea. J Gastroenterol 39:815–820PubMedCrossRefGoogle Scholar
  28. 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 20:1153–1159PubMedCrossRefGoogle Scholar
  29. 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 163:41–45PubMedCrossRefGoogle Scholar
  30. 30.
    Kerr P, Shoenut JP, Millar T, Buckle P, Kryger MH (1992) Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest 101:1539–1544PubMedCrossRefGoogle Scholar
  31. 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 130:1003–1008PubMedCrossRefGoogle Scholar
  32. 32.
    Margel D, Cohen M, Livne PM, Pillar G (2004) Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 63:545–549PubMedCrossRefGoogle Scholar
  33. 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 17:186–190PubMedCrossRefGoogle Scholar
  34. 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 4:1153–1162PubMedCrossRefGoogle Scholar
  35. 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 67:974–977PubMedCrossRefGoogle Scholar
  36. 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 32:1049–1057PubMedGoogle Scholar
  37. 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 13:1086–1090PubMedCrossRefGoogle Scholar
  38. 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 -->Google Scholar
  39. 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 17:160–167PubMedGoogle Scholar
  40. 40.
    Zias N, Bezwada V, Gilman S, Chroneou A (2009) Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor? Sleep Breath 13:3–10PubMedCrossRefGoogle Scholar
  41. 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 16:256–260PubMedCrossRefGoogle Scholar
  42. 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 39:547–552PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ivo A. C. Cruz
    • 1
  • Marta Drummond
    • 1
  • João C. Winck
    • 1
  1. 1.Department of Pulmonology, São João Hospital, Faculty of MedicineUniversity of PortoPortoPortugal

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