Subjective apnea symptoms are associated with daytime sleepiness in patients with moderate and severe obstructive sleep apnea: a retrospective study

Abstract

Objectives

Most previous studies have failed to show a relation between daytime sleepiness and apnea severity in patients with obstructive sleep apnea (OSA). We determined the relation between daytime sleepiness and subjective and objective apnea severity in newly-diagnosed patients with moderate to severe OSA.

Design

Retrospective cross-sectional study.

Setting

Tertiary referral centre.

Participants

A total of 559 adults with newly-diagnosed moderate and severe OSA.

Main outcome measures

Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Subjective and objective apnea severities were assessed using the Sleep Breathing Scale (SBS) and polysomnography, respectively. Sleep quality and depressive symptoms were evaluated using Medical Outcomes Study-Sleep Scale and Beck Depression Inventory (BDI), respectively.

Results

The mean ESS score was 9.8 (SD 5.0). ESS score was correlated with SBS score (p<0.001), apnea-hypopnea index (AHI) (p=0.027), minimal oxygen saturation (MinSaO₂) (p=0.021), body mass index (BMI) (p=0.007), and BDI score (p<0.001). Linear regression analysis showed that higher SBS (p=0.005) and BDI scores (p<0.001) were associated with higher ESS score after controlling for gender, BMI, and AHI. Apnea-hypopnea index, MinSaO₂, and BMI were not independently related to ESS score.

Conclusions

Daytime sleepiness was related to subjective OSA symptoms but not objective apnea severity measured by polysomnography in patients with moderate to severe OSA. These findings suggest the usefulness of the subjective apnea severity as an indicator of OSA disease severity.

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