The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep.
The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep.
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DOI：
10.1093/sleep/25.3.307
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发表时间：
2002-05
期刊：
影响因子：
5.6
通讯作者：
N. Punjabi;K. Bandeen-Roche;Jason J. Marx;D. Neubauer;Philip L. Smith;A. Schwartz
中科院分区：
文献类型：
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作者：
N. Punjabi;K. Bandeen-Roche;Jason J. Marx;D. Neubauer;Philip L. Smith;A. Schwartz
白天嗜睡在睡眠呼吸障碍患者中很常见。虽然睡眠期间的呼吸事件与日间嗜睡的发生相关，但这些事件在非快速眼动（NREM）和快速眼动（REM）睡眠期间对日间嗜睡的不同影响尚未得到很好的表征。通过多次睡眠潜伏期试验（MREM）评估，确定REM睡眠和NREM睡眠期间呼吸事件对日间嗜睡的影响。设计横断面研究。单位：大学睡眠障碍实验室。参与者：接受多导睡眠图和日间监测的患者（n= 1，821）。干预措施测量和结果研究样本最初根据NREM睡眠期间的呼吸暂停低通气指数（AHI）水平分为四分位数。在NREM-AHI的第一个四分位数（NREM-AHI < 8.3次/小时）内，使用Kaplan-Meier分析和考克斯比例风险回归方法检查REM相关呼吸事件与日间嗜睡之间的关联。调整年龄、性别、体重指数、非快速眼动睡眠和快速眼动睡眠持续时间后，REM-AHI与日间嗜睡无关（相对危险度：1.01; 95%CI：0.94-1.10）。同样，在第二至第四NREM-AHI四分位数内的患者中，未观察到REM-AHI与MCAH之间的显著相关性。相比之下，NREM睡眠期间呼吸紊乱的严重程度增加与白天嗜睡有关。NREM-AHI每增加10分，NREM-AHI第二至第四个四分位数的日间嗜睡校正相对危险度分别为1.21（95%CI：1.01-1.46）、1.20（95%CI：1.05-1.37）和1.10（95%CI：1.04-1.16）。结论：非快速眼动睡眠期的睡眠呼吸障碍与日间嗜睡风险增加相关，而快速眼动睡眠期与此无关。
BACKGROUND Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. STUDY OBJECTIVES To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). DESIGN Cross-sectional study. SETTING University-based sleep disorders laboratory. PARTICIPANTS Patients referred for polysomnography and daytime MSLT (n=1,821). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI < 8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. CONCLUSION Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.