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Energy expenditure in obstructive sleep apnea: validation of a multiple physiological sensor for determination of sleep and wake

Abstract

Purpose

Obstructive sleep apnea (OSA) may be associated with increased energy expenditure (EE) during sleep. As actigraphy is inaccurate at estimating EE from body movement counts alone, we aimed to compare a multiple physiological sensor with polysomnography for determination of sleep and wake, and to test the hypothesis that OSA is associated with increased EE during sleep.

Methods

We studied 50 adults referred for routine overnight polysomnography. In addition to polysomnography, the SenseWear Pro3 ArmbandTM (Bodymedia Inc.) was placed on the upper right arm. Epoch-by-epoch agreement rate between the measures of sleep versus wake was calculated. Linear regression analyses were performed for EE against apnea–hypopnea index (AHI), 3% oxygen desaturation index (ODI), body mass index (BMI), waist–hip ratio (WHR), gender, age, and average heart rate during sleep.

Results

The epoch-by-epoch agreement rate was high (79.9 ± 1.6%) and the ability of the SenseWear to estimate sleep was very good (sensitivity, 88.7 ± 1.5%). However, it was less accurate in determining wake (specificity 49.9 ± 3.6%). Sleep EE was associated with AHI, 3% ODI, BMI, WHR, and male gender (p < 0.001 for all). Stepwise multiple linear regression however revealed that BMI, male gender, age, and average heart rate during sleep were independent predictors of EE (Model R 2 = 0.78).

Conclusions

The SenseWear armband provides a reasonable estimation of sleep but a poor estimation of wake. Furthermore, in a selected population of OSA patients, increasing OSA severity is associated with increased EE during sleep, although primarily through an association with increased BMI. However, as our data are not adjusted for fat-free mass and the SenseWear has yet to be validated for EE in OSA patients, these data should be interpreted with caution.

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References

  1. 1.

    Peppard P, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284(23):3015–21

  2. 2.

    Newman A, Foster G, Givelber R, Nieto F, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165(20):2408–13

  3. 3.

    Stenlof K, Grunstein R, Hedner J, Sjostrom L (1996) Energy expenditure in obstructive sleep apnea: effects of treatment with continuous positive airway pressure. Am J Physiol 271(6 Pt 1):E1036–43

  4. 4.

    Lin C, Chang K, Lee K (2002) Effects of treatment by laser-assisted uvuloplasty on sleep energy expenditure in obstructive sleep apnea patients. Metabolism 51(5):622–7

  5. 5.

    Ryan C, Love L, Buckley P (1995) Energy expenditure in obstructive sleep apnea. Sleep 18(3):180–7

  6. 6.

    Leenders N, Sherman W, Nagaraja H (2006) Energy expenditure estimated by accelerometry and doubly labeled water: do they agree? Med Sci Sports Exerc 38(12):2165–72

  7. 7.

    Fruin M, Rankin J (2004) Validity of a multi-sensor armband in estimating rest and exercise energy expenditure. Med Sci Sports Exerc 36(6):1063–9

  8. 8.

    Jakicic J, Marcus M, Gallagher K, Randall C, Thomas E, Goss F, Robertson R (2004) Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise. Med Sci Sports Exerc 36(5):897–904

  9. 9.

    St-Onge M, Mignault D, Allison D, Rabasa-Lhoret R (2007) Evaluation of a portable device to measure daily energy expenditure in free-living adults. Am J Clin Nutr 85(3):742–9

  10. 10.

    Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

  11. 11.

    Weiss A, Johnson N, Berger N, Redline S (2010) Validity of activity-based devices to estimate sleep. J Clin Sleep Med 6(4):336–42

  12. 12.

    Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak C (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26(3):342–92

  13. 13.

    Sadeh A, Sharkey K, Carskadon M (1994) Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep 17(3):201–7

  14. 14.

    Sadeh A, Hauri P, Kripke D, Lavie P (1995) The role of actigraphy in the evaluation of sleep disorders. Sleep 18(4):288–302

  15. 15.

    de Souza L, Benedito-Silva A, Pires M, Poyares D, Tufik S, Calil H (2003) Further validation of actigraphy for sleep studies. Sleep 26(1):81–5

  16. 16.

    Montgomery-Downs HE, Insana SP, Bond JA (2011) Movement toward a novel activity monitoring device. Sleep Breath. doi:10.1007/s11325-011-0585-y

  17. 17.

    Kellner O, Bastuji H, Adeleine P (1997) Actimetry in sleep medicine. Sleep Breath 2(1):33–39

  18. 18.

    Hyde M, O’Driscoll D, Binette S, Galang C, Tan S, Verginis N, Davey M, Horne R (2007) Validation of actigraphy for determining sleep and wake in children with sleep disordered breathing. J Sleep Res 16(2):213–6

  19. 19.

    Kushida C, Chang A, Gadkary C, Guilleminault C, Carrillo O, Dement W (2001) Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med 2(5):389–96

  20. 20.

    Hamilton G, Solin P, Naughton M (2004) Obstructive sleep apnoea and cardiovascular disease. Intern Med J 34(7):420–6

  21. 21.

    Kezirian E, Kirisoglu C, Riley R, Chang E, Guilleminault C, Powell N (2008) Resting energy expenditure in adults with sleep disordered breathing. Arch Otolaryngol Head Neck Surg 134(12):1270–5

  22. 22.

    Patel S, Benzo R, Slivka W, Sciurba F (2007) Activity monitoring and energy expenditure in COPD patients: a validation study. COPD 4(2):107–12

  23. 23.

    O’Driscoll D, Horne R, Davey M, Hope S, Anderson V, Trinder J, Walker A, Nixon G (2011) Increased sympathetic activity in children with obstructive sleep apnea: cardiovascular implications. Sleep Med 12(5):483–8

  24. 24.

    Haba-Rubio J, Darbellay G, Herrmann FR, Frey JG, Fernandes A, Vesin JM, Thiran JP, Tschopp JM (2005) Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep. Sleep Breath 9(2):73–81

  25. 25.

    Bonnet M, Berry R, Arand D (1991) Metabolism during normal, fragmented, and recovery sleep. J Appl Physiol 71(3):1112–8

  26. 26.

    Mannix E, Manfredi F, Farber M (1999) Elevated O2 cost of ventilation contributes to tissue wasting in COPD. Chest 115(3):708–13

  27. 27.

    Gershan W, Forster H, Lowry T, Korducki M, Forster A, Forster M, Ohtake P, Aaron E, Garber A (1994) Effect of metabolic rate on ventilatory roll-off during hypoxia. J Appl Physiol 76(6):2310–4

  28. 28.

    Solin P, Kaye DM, Little PJ, Bergin P, Richardson M, Naughton MT (2003) Impact of sleep apnea on sympathetic nervous system activity in heart failure. Chest 123(4):1119–26

  29. 29.

    Maquet P, Dive D, Salmon E, Sadzot B, Franco G, Poirrier R, von Frenckell R, Franck G (1990) Cerebral glucose utilization during sleep-wake cycle in man determined by positron emission tomography and [18 F]2-fluoro-2-deoxy-D-glucose method. Brain Res 513(1):136–43

  30. 30.

    Franzini C (1992) Brain metabolism and blood flow during sleep. J Sleep Res 1(1):3–16

  31. 31.

    Katayose Y, Tasaki M, Ogata H, Nakata Y, Tokuyama K, Satoh M (2009) Metabolic rate and fuel utilization during sleep assessed by whole-body indirect calorimetry. Metabolism 58(7):920–6

  32. 32.

    White D, Weil J, Zwillich C (1985) Metabolic rate and breathing during sleep. J Appl Physiol 59(2):384–91

  33. 33.

    Jung C, Melanson E, Frydendall E, Perreault L, Eckel R, Wright K (2011) Energy expenditure during sleep, sleep deprivation and sleep following sleep deprivation in adult humans. J Physiol 589(Pt 1):235–44

  34. 34.

    Geer E, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend Med 6(Suppl 1):60–75

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Acknowledgments

The authors would like to thank all the staff of the Department of Respiratory and Sleep Medicine at Monash Medical Centre and all the participants in this study.

Financial support

This project was supported by a National Health and Medical Research Council of Australia Equipment Grant.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Denise M. O’Driscoll.

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O’Driscoll, D.M., Turton, A.R., Copland, J.M. et al. Energy expenditure in obstructive sleep apnea: validation of a multiple physiological sensor for determination of sleep and wake. Sleep Breath 17, 139–146 (2013). https://doi.org/10.1007/s11325-012-0662-x

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Keywords

  • Obstructive sleep apnea
  • Energy expenditure
  • Validation
  • Polysomnography
  • Arousal
  • Oxygen desaturation