Clinical and polysomnographic differences between OSAH patients with/without excessive daytime sleepiness
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ORIGINAL ARTICLE
Clinical and polysomnographic differences between OSAH patients with/without excessive daytime sleepiness Jorge Rey de Castro & Edmundo Rosales-Mayor
Received: 28 September 2012 / Revised: 3 December 2012 / Accepted: 3 January 2013 / Published online: 23 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose The purpose of this study is to describe the clinical and polysomnographic differences found in patients diagnosed with obstructive sleep apnea–hypopnea (OSAH), with or without excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS). Methods A physical examination, ESS, and polysomnography were applied to all the participants, considering an ESS score of >10 to indicate EDS and an ESS score of ≥16 to indicate severe EDS. Univariate (chi-squared or Student’s t test) and multivariate (multiple logistic regression) analysis approaches were used. A value of p3 % oxygen desaturation and/or respiratory arousal. Respiratory events were classified as obstructive if accompanied by thoracic or abdominal effort; central if there was no respiratory effort, and mixed if both coexisted, with initial central apnea followed by an obstructive event. The Apnea–Hypopnea Index (AHI) was calculated as the sum of all respiratory events, divided by the total number of sleep hours. Maximum desaturation (MaxDes) point was defined as the lowest nighttime saturation point and percentage of sleep time with oxygen saturation below 90 % (T90), calculated as the quotient of the time in minutes with saturation levels below 90 %, divided by the total number of minutes of sleep time, and multiplied by 100. The scoring of sleep stages and sleep events was done manually. The severity of the event was rated using the AHI scale: a mild OSAH meant an AHI score between 5 and less than 15; a moderate OSAH was between 15 and less than 30; and a severe OSAH was 30 or more. The weight and height of each patient were taken to calculate the Body Mass Index (BMI) in kilograms per square meter. We used the method proposed by Lohman [19] for measuring the cervical circumference. Epworth sleepiness scale This tool, designed by Murray W. Johns in 1991 [13], subjectively measures sleepiness. It consists of a brief self-applied eight-point questionnaire that investigates the possibility of a person falling asleep during various daily activities, with scores ranging from 0 to 24. We used a customized version of this tool, validated, modified, and adapted to Peruvian people [20]. A score higher than 10 reveals EDS [15], and a score of 16 or higher indicates severe EDS [13, 21]. Statistical analysis Data were analyzed as n (%) for categorical variables, and mean±standard deviation for continuous variables. For the univariate analysis of categorical variables, a chi-square test was used. For the comparison of two samples’ mean, a student t test was used. Based on the possible EDS values, two comparisons were made: the first compared the population without EDS (ESS≤10) and with EDS (ESS>10), and the second co
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