Skip to main content
SpringerLink
Log in

Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing

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

Abstract

Objectives

In a large clinical sample, we tested the hypothesis that levels of sleepiness and fatigue among upper airway resistance syndrome (UARS) patients are correlated with levels of somatic arousal (SA; reflecting the sympathetic nervous system component of the stress response). We also tested the correlations of post-treatment change in these three parameters, and we extended the investigation to obstructive sleep apnea/hypopnea (OSA/H) patients.

Methods

From 5 years of patient data, we obtained scores on the body sensation questionnaire (BSQ), measuring the level of SA, the fatigue severity scale (FSS), and Epworth sleepiness scale (ESS) for 152 consecutive UARS patients and 150 consecutive OSA/H patients. For each group, we correlated the FSS and ESS scores with the BSQ scores. Among the 45 UARS patients and 49 OSA/H patients treated with nasal CPAP who provided post-treatment data, we correlated change in FSS and ESS scores with change in BSQ scores.

Results

Scores on the BSQ, FSS, and ESS for UARS patients and OSA/H patients were comparable. In both UARS and OSA/H patients, both the FSS and ESS scores were positively correlated with the BSQ score. Nasal CPAP use decreased all three questionnaire scores in both patient groups. In the pooled data, changes in FSS were significantly correlated with changes in BSQ.

Conclusions

Our findings confirm our preliminary observations that sleepiness and fatigue among UARS patients are correlated with their level of SA and suggest that the same is true for OSA/H patients. The decrease of SA following treatment suggests that SDB is a cause of SA among patients with UARS and OSA/H.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dement W, Carskadon M, Richardson G (1978) Excessive daytime sleepiness in the sleep apnea syndrome. In: Guilleminault C, Dement W (eds) Sleep apnea syndromes. Alan R. Liss Inc., New York, pp. 23–46

    Google Scholar 

  2. Singh B (1984) Sleep apnea: a psychiatric perspective. In: Saunders N, Sullivan C (eds) Sleep and breathing, Lung biology in health and disease, vol 21. Marcel Dekker, New York, pp. 403–422

    Google Scholar 

  3. Gold AR, Gold MS, Harris KW, Espeleta VJ, Amin MM, Broderick JE (2008) Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome. Sleep Med 9(6):675–683

    Article  PubMed  Google Scholar 

  4. Punjabi NM, O’Hearn DJ, Neubauer DN, Nieto FJ, Schwartz AR, Smith PL, Bandeen-Roche K (1999) Modeling hypersomnolence in sleep-disordered breathing. A novel approach using survival analysis. Am J Respir Crit Care Med 159(6):1703–1709

    Article  CAS  PubMed  Google Scholar 

  5. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P (1993) A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 104(3):781–787

    Article  CAS  PubMed  Google Scholar 

  6. Amin MM, Belisova Z, Hossain S, Gold MS, Broderick JE, Gold AR (2011) Inspiratory airflow dynamics during sleep in veterans with Gulf War illness: a controlled study. Sleep Breath 15(3):333–339

    Article  PubMed  Google Scholar 

  7. Gold AR, Broderick JE, Amin MM, Gold MS (2009) Inspiratory airflow dynamics during sleep in irritable bowel syndrome: a pilot study. Sleep Breath 13(4):397–407

    Article  PubMed  Google Scholar 

  8. Gold AR, Broderick JE, Gold MS, Amin MM (2013) A comparison of inspiratory airflow dynamics during sleep between upper airway resistance syndrome patients and healthy controls. Sleep Breath 17(4):1169–1178

    Article  PubMed  Google Scholar 

  9. Pavlova MK, Duffy JF, Shea SA (2008) Polysomnographic respiratory abnormalities in asymptomatic individuals. Sleep 31(2):241–248

    PubMed  PubMed Central  Google Scholar 

  10. Broderick JE, Gold MS, Amin MM, Gold AR (2012) Self-report somatic arousal correlates with sleep complaints among females with irritable bowel syndrome: a pilot study. J Sleep Disor: Treat Care 1:2

    Google Scholar 

  11. Broderick JE, Gold MS, Amin MM, Gold AR (2014) The association of somatic arousal with the symptoms of upper airway resistance syndrome. Sleep Med 15(4):436–443

    Article  PubMed  Google Scholar 

  12. Watson D, Weber K, Assenheimer JS, Clark LA, Strauss ME, McCormick RA (1995) Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. J Abnorm Psychol 104(1):3–14

    Article  CAS  PubMed  Google Scholar 

  13. National Institute of Mental Health (2009) Anxiety disorders. US Department of Health and Human Services, NIH, Bethesda, MD

    Google Scholar 

  14. Lin SW, Chen YL, Kao KC, Yang CT, Chuang LP, Chou YT, Lai SC, Chen RS, Chen NH (2013) Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome. PLoS One 8(8):e71499

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P (2007) Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 30(3):312–319

    PubMed  Google Scholar 

  16. Delgado Rodrigues RN, Alvim de Abreu E Silva Rodrigues AA, Pratesi R, Krieger J (2006) Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas. Sleep Med 7(3):235–239

  17. Gold AR, Marcus CL, Dipalo F, Gold MS (2002) Upper airway collapsibility during sleep in upper airway resistance syndrome. Chest 121(5):1531–1540. doi:10.1378/chest.121.5.1531

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  19. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    CAS  PubMed  Google Scholar 

  20. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123

    Article  CAS  PubMed  Google Scholar 

  21. (2011). Base SAS_ 9.3 Procedures guide: Statistical Procedures SAS Institute Inc, Cary, NC

  22. Gold AR, Dipalo F, Gold MS, O’Hearn D (2003) The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes. Chest 123(1):87–95

    Article  PubMed  Google Scholar 

  23. Vgontzas AN, Papanicolao DA, Bixler EO, Hopper K, Lotsikas A, Lin H-M, Kales A, Chrousos GP (2000) Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 85(3):1151–1158

    Article  CAS  PubMed  Google Scholar 

  24. Gold AR (2011) Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms. Sleep Med Rev 15(6):389–401

    Article  PubMed  Google Scholar 

  25. Carlson JT, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin BG (1993) Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest 103(6):1763–1768

    Article  CAS  PubMed  Google Scholar 

  26. Narkiewicz K, van de Borne PJ, Cooley RL, Dyken ME, Somers VK (1998) Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation 98(8):772–776

    Article  CAS  PubMed  Google Scholar 

  27. Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK (1999) Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 100(23):2332–2335

    Article  CAS  PubMed  Google Scholar 

  28. Donadio V, Liguori R, Vetrugno R, Contin M, Elam M, Wallin BG, Karlsson T, Bugiardini E, Baruzzi A, Montagna P (2007) Daytime sympathetic hyperactivity in OSAS is related to excessive daytime sleepiness. J Sleep Res 16(3):327–332

    Article  PubMed  Google Scholar 

  29. Lombardi C, Parati G, Cortelli P, Provini F, Vetrugno R, Plazzi G, Vignatelli L, Di Rienzo M, Lugaresi E, Mancia G, Montagna P, Castiglioni P (2008) Daytime sleepiness and neural cardiac modulation in sleep-related breathing disorders. J Sleep Res 17(3):263–270

    Article  PubMed  Google Scholar 

  30. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP (2004) Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab 89(9):4409–4413

    Article  CAS  PubMed  Google Scholar 

  31. Li X, Kan EM, Lu J, Cao Y, Wong RK, Keshavarzian A, Wilder-Smith CH (2013) Combat-training increases intestinal permeability, immune activation and gastrointestinal symptoms in soldiers. Aliment Pharmacol Ther 37(8):799–809

    Article  CAS  PubMed  Google Scholar 

  32. Lindqvist D, Wolkowitz OM, Mellon S, Yehuda R, Flory JD, Henn-Haase C, Bierer LM, Abu-Amara D, Coy M, Neylan TC, Makotkine I, Reus VI, Yan X, Taylor NM, Marmar CR, Dhabhar FS (2014) Proinflammatory milieu in combat-related PTSD is independent of depression and early life stress. Brain Behav Immun 42:81–88

    Article  PubMed  Google Scholar 

  33. Agnew Jr HW, Webb WB, Williams RL (1966) The first night effect: an EEG study of sleep. Psychophysiology 2(3):263–266

    Article  PubMed  Google Scholar 

  34. Moser D, Kloesch G, Fischmeister FP, Bauer H, Zeitlhofer J (2010) Cyclic alternating pattern and sleep quality in healthy subjects–is there a first-night effect on different approaches of sleep quality? Biol Psychol 83(1):20–26

    Article  PubMed  Google Scholar 

  35. Petersen H, Kecklund G, D’Onofrio P, Nilsson J, ÅKerstedt T (2013) Stress vulnerability and the effects of moderate daily stress on sleep polysomnography and subjective sleepiness. J Sleep Res 22(1):50–57

    Article  PubMed  Google Scholar 

  36. Theorell-Haglow J, Lindberg E, Janson C (2006) What are the important risk factors for daytime sleepiness and fatigue in women? Sleep 29(6):751–757

    PubMed  Google Scholar 

  37. Lee SY, Wuertz C, Rogers R, Chen YP (2013) Stress and sleep disturbances in female college students. Am J Health Behav 37(6):851–858

    Article  PubMed  Google Scholar 

  38. Ekstedt M, Soderstrom M, Akerstedt T, Nilsson J, Sondergaard HP, Aleksander P (2006) Disturbed sleep and fatigue in occupational burnout. Scand J Work Environ Health 32(2):121–131

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary/Critical Care/Sleep Medicine, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA

    Tshering Amdo, Nadia Hasaneen & Avram R. Gold

  2. GlaxoSmithKline Consumer Health, Parsippany, NJ, 07054, USA

    Morris S. Gold

  3. DVA Medical Center, Northport, NY, 11768, USA

    Tshering Amdo, Nadia Hasaneen & Avram R. Gold

Authors
  1. Morris S. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tshering Amdo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadia Hasaneen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Avram R. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Avram R. Gold.

Ethics declarations

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

No funding was received for this research.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Electronic supplementary material

ESM 1

(DOC 29 kb)

ESM 2

(PDF 404 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gold, M.S., Amdo, T., Hasaneen, N. et al. Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing. Sleep Breath 20, 749–758 (2016). https://doi.org/10.1007/s11325-015-1294-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-015-1294-8

Keywords

Search

Navigation