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Sleep-related cortical arousals in adult subjects with negative polysomnography

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Abstract

Purpose

The arousal index (AI) quantifies cortical arousal relative to total sleep time and is widely used to determine the severity of sleep fragmentation. It usually includes arousals secondary to respiratory events, limb movements, and spontaneous arousals. No systematic studies have been undertaken to determine AI cutoff in subjects with negative polysomnography.

Methods

Three hundred fifty polysomnograms of subjects ≥18 years of age with no sleep disorders (apnea-hypopnea index (AHI) <5, periodic limb movement index (PLMI) <10, no upper airway resistance syndrome) or minimum oxygen saturation > 90 % and no comorbid health problems were reviewed.

Results

Basic sleep architecture appears within normal range, except for increased stage N2 and decreased stage N3. AI significantly correlated with age (r = 0.7), sleep efficiency (r =−0.16), sleep latency (r = 0.14), rapid eye movement (REM) latency (r = 0.12), stage N1 (r = 0.15), stage N2 (r = 0.12), stage N3 (r = −0.27), AHI (r = 0.24), PLMI (r = 0.18), and nadir oxygen saturation (r = −0.17) [p < 0.05 for all]. A significant correlation was noted between age and sleep efficiency (r = −0.19), REM latency (r = 0.13), stage N1 (r = 0.16), stage N2 (r = 0.21), stage N3 (r = −0.39), and nadir oxygen saturation (r = −0.16) [p < 0.05 for all]. Multiple linear regression analysis showed that age is only the independent predictor of AI (R 2 = 0.70, p < 0.01). The prediction equation for the arousal index in subject with negative polysomnography is AI = 0.276 × age (year) + 8.018.

Conclusions

Age is the most important independent factor in predicting increasing AI in subjects with negative polysomnography.

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Abbreviations

OSAS:

Obstructive sleep apnea syndrome

EDS:

Excessive daytime sleepiness

ESS:

Epworth Sleepiness Scale

TST:

Total sleep time

PSG:

Polysomnogram

AHI:

Apnea-hypopnea index

RDI:

Respiratory disturbance index

AI:

Arousal index

PLMI:

Periodic limbs movements index

PLMAI:

Periodic limbs movements arousal index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

REM:

Rapid eye movement

SPSS:

Statistical Package for the Social Sciences

EOG:

Electrooculogram

EMG:

Electromyogram

ECG:

Electrocardiography

SpO2:

Pulse oxygen saturation

WASO:

Wake after sleep onset

ASDA:

American Sleep Disorders Association

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Acknowledgments

The authors gratefully acknowledge the contribution of Dr. Nancy Foldvary-Schaefer and Kingman P. Strohl for their thoughtful review and comments of the manuscript and Nengah Hariadi and Zahreddin Alsheikhtaha for technical support.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand

    Nattapong Jaimchariyatam

  2. Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Nattapong Jaimchariyatam

  3. Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Carlos L. Rodriguez & Kumar Budur

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  1. Nattapong Jaimchariyatam
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  2. Carlos L. Rodriguez
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  3. Kumar Budur
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Correspondence to Nattapong Jaimchariyatam.

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Jaimchariyatam, N., Rodriguez, C.L. & Budur, K. Sleep-related cortical arousals in adult subjects with negative polysomnography. Sleep Breath 19, 989–996 (2015). https://doi.org/10.1007/s11325-014-1090-x

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  • DOI: https://doi.org/10.1007/s11325-014-1090-x

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