Abstract
A sample of 32 obstructive sleep apnea patients (27 males, 5 females) was assessed with overnight polysomnography and the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Patients also participated in a maximal exercise test, which served as an objective indicator of physical fatigue. The Fatigue Severity Scale (FSS) was used as a subjective measure of fatigue. Subjective fatigue ratings were significantly correlated with percent of predicted maximum heart rate achieved during exercise testing, suggesting that self-reported fatigue in apnea patients may refer to reduced physical fitness. FSS scores and exercise testing results were not significantly correlated with the MSLT, indicating that daytime fatigue and daytime sleepiness are independent problems in apnea patients. Participants self-reported a high level of fatigue, and exercise testing revealed decreased physical work capacity among apnea patients, but objective and subjective indicators of fatigue were not significantly correlated with apnea severity. A higher percentage of REM sleep predicted greater work capacity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
American Sleep Disorders Association. (1992). The clinical use of the multiple sleep latency test. Sleep, 15, 268–276.
Bond, V., Balkissoon, B., Franks, B. D., Brwnlow, R., Caprarola, M., Bartley, D., & Banks, M. (1986). Effects of sleep deprivation on performance during submaximal and maximal exercise. Journal of Sports Medicine, 26, 169–174.
Carskadon, M. A., Dement, W. C., Mitler, M. M., Roth, T., Westbrook, P. R., & Keenan, S. (1986). Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. Sleep, 9, 519–524.
Chen, H. (1991). Effects of 30-h sleep loss on cardiorespiratory functions at rest and in exercise. Medicine and Science in Sports and Exercise, 23, 193–198.
Edinger, J. D., Morey, M. C., Sullivan, R. J., Higginbotham, M. B., Marsh, G. R., Dailey, D. S., & McCall, W. V. (1993). Aerobic fitness, acute exercise and sleep in older men. Sleep, 16, 351–359.
Hansen, J. E., Sue, D. Y., & Wasserman, K. (1984). Predicted values for clinical exercise testing. American Review of Respiratory Disease, 129(Suppl.) S49–S55.
Horne, J. A., & Pettitt, A. N. (1984). Sleep deprivation and the physiological response to exercise under steady-state conditions in untrained subjects. Sleep, 7, 168–179.
Kales, A., Cadieux, R. J., Bixler, E. O., Soldatos, C. R., Vela-Bueno, A., Misoul, C. A., & Locke, T. W. (1985). Severe obstructive sleep apnea-I: Onset, clinical course, and characteristics. Journal of Chronic Diseases, 38, 419–425.
Krieger, J. (1990). Obstructive sleep apnea: Clinical manifestations and pathophysiology. In M. J. Thorpy (Ed.), Handbook of Sleep Disorders (pp. 259–284). New York: Marcel Dekker.
Krupp, L. B., Jandorf, L., Coyle, P. K., & Mendelson, W. B. (1993). Sleep disturbance in chronic fatigue syndrome. Journal of Psychosomatic Research, 37, 325–331.
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The Fatigue Severity Scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123.
Lamphere, J., Roehrs, T., Wittig, R., Zorick, F., Conway, W. A., & Roth, T. (1989). Recovery of alertness after CPAP in apnea. Chest, 96, 1364–1367.
Levy, P. A., Guilleminault, C., Fagret, D., Gaio, J. M., Romand, P., Bonnet, C., Pison, C. M., Wolf, J. E., & Paramelle, B. (1991). Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnoea syndrome. European Respiratory Journal, 4, 347–352.
Lichstein, K. L., Means, M. K., Noe, S. L., & Aguillard, R. N. (1997). Fatigue and sleep disorders. Behaviour Research and Therapy, 35, 733–740.
Martin, B. J. (1988). Sleep loss and subsequent exercise performance. Acta Physiologica Scandinavica, 133, 28–32.
Mezzanotte, W. S., Tangel, D. J., Fox, A. M., Ballard, R. D., & White, D. P. (1994). Nocturnal nasal continuous positive airway pressure in patients with chronic obstructive pulmonary disease: Influence on waking respiratory muscle function. Chest, 106, 1100–1108.
Mitler, M. M., Gujavarty, K. S., & Browman, C. P. (1982). Maintenance of wakefulness test: A polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence. Electroencephalography and Clinical Neurophysiology, 53, 658–661.
Montgomery, I., Trinder, J., & Paxton, S. J. (1982). Energy expenditure and total sleep time: Effect of physical exercise. Sleep, 5, 159–168.
Packer, T. L., Martins, I., Krefting, L., & Brouwer, B. (1991). Activity and post-polio fatigue. Orthopedics, 14, 1223–1226.
Rangemark, C., Hedner, J. A., Carlson, J. T., Gleerup, G., & Winther, K. (1995). Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients. Sleep, 18, 188–194.
Rechtschaffen, A., & Kales, A. (1968). A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service/Brain Research Institute, UCLA.
Reynolds, C. F., III, Coble, P. A., Kupfer, D. J., & Holzer, B. C. (1982). Application of the multiple sleep latency test in disorders of excessive sleepiness. Electroencephalography and Clinical Neurophysiology, 53, 443–452.
Shephard, R. J. (1984). Sleep, biorhythms and human performance. Sports Medicine, 1, 11–37.
Smith, C. (1995). Sleep states and memory processes. Behavioural Brain Research, 69, 137–145.
Symons, J. D., Vanhelder, T., & Myles, W. S. (1988). Physical performance and physiological responses following 60 hours of sleep deprivation. Medicine and Science in Sports and Exercise, 20, 374–380.
Torsvall, L. (1981). Sleep after exercise: A literature review. Journal of Sports Medicine and Physical Fitness, 21, 218–225.
Wasserman, K., Hansen, J. E., Sue, D. Y., Whipp, B. J., & Casaburi, R. (1994). Principles of exercise testing and interpretation (2nd ed.). Philadelphia: Lea & Febiger.
Weitzenblum, E., Krieger, J., Apprill, M., Vallee, E., Ehrhart, M., Ratomaharo, J., Oswald, M., & Kurtz, D. (1988). Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. American Review of Respiratory Disease, 138, 345–349.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aguillard, R.N., Riedel, B.W., Lichstein, K.L. et al. Daytime Functioning in Obstructive Sleep Apnea Patients: Exercise Tolerance, Subjective Fatigue, and Sleepiness. Appl Psychophysiol Biofeedback 23, 207–217 (1998). https://doi.org/10.1023/A:1022257514209
Issue Date:
DOI: https://doi.org/10.1023/A:1022257514209