Does snoring predict sleepiness independently of apnea and hypopnea frequency?
Does snoring predict sleepiness independently of apnea and hypopnea frequency?
复制标题
DOI：
10.1164/ajrccm.162.4.9911073
复制
发表时间：
2000-10-01
影响因子：
24.7
通讯作者：
Mahowald, MW
中科院分区：
文献类型：
--
作者：
Gottlieb, DJ;Yao, Q;Mahowald, MW
睡眠中的阻塞性呼吸暂停和低呼吸是公认的导致白天过度困倦的原因。打呼噜也与过度嗜睡有关，尽管目前尚不清楚这是否反映了鼾声的独立影响，或者鼾声只是阻塞性睡眠呼吸暂停的一个标志。为了进一步探索打鼾症与嗜睡的关系，我们对参与睡眠心脏健康研究的居住在社区的成年人进行了一项横断面队列研究。研究样本包括2737名男性和3040名女性，平均年龄为(SD 11岁)。嗜睡程度采用爱普沃斯嗜睡量表(ESS)进行量化。打鼾史是通过自填问卷获得的。在家庭多导睡眠监测中测量呼吸紊乱指数(RDI)，定义为每小时睡眠中呼吸暂停和低呼吸的次数。ESS评分随着RDI值的增加而递增，从RDI1.5分的平均值7.1分增加到大于或等于15分的8.8分(P<；0.001)。在五种类型的打鼾者中，睡眠呼吸暂停评分也逐渐增加，从目前不打鼾者的6.4%(4.2%)增加到每周打鼾者的9.3%(4.8%)(p<；0.001)。白天过度嗜睡的发生率，定义为ESS评分大于或等于11，从从不打鼾者的15%上升到每周打鼾者的39%。鼾症与嗜睡的关系在RDI的各个水平上都可以看到，在多变量模型中调整RDI后，鼾声与ESS评分的关系没有显著变化。对年龄、性别、种族、体重指数的调整，或睡眠时间不足或夜间腿部痉挛或抽筋的问卷证据，对鼾声和RDI对嗜睡的影响很小。我们的结论是，在社区居住的中老年人中，鼾声和RDI都独立地与过度嗜睡有关。
Obstructive apneas and hypopneas during sleep are a well recognized cause of excessive daytime sleepiness. Snoring is also associated with excess sleepiness, although it is not known whether this reflects an independent effect of snoring or whether snoring is simply a marker for obstructive sleep apnea. To further explore the relation of snoring to sleepiness, we conducted a cross-sectional cohort study of community-dwelling adults participating in the Sleep Heart Health Study. The study sample comprises 2737 men and 3,040 women with a mean age of 64 (SD 11) yr. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS). Snoring history was obtained via a self-completion questionnaire. The respiratory disturbance index (RDI), defined as the number of apneas plus hypopneas per hour of sleep, was measured during in-home polysomnography. The ESS score increased progressively with increasing RDI, from a mean of 7.1 (4.2) in subjects with RDI < 1.5 to 8.8 (4.8) in subjects with RDI greater than or equal to 15 (p < 0.001). A progressive increase in ESS score was also seen across five categories of snoring frequency, from 6.4 (4.2) in current nonsnorers to 9.3 (4.8) in subjects who snored six to seven nights per week (p < 0.001). The prevalence of excessive daytime sleepiness, defined as an ESS score greater than or equal to 11, increased from 15% in never-snorers to 39% in those who snored six to seven nights per week. The relation of snoring to sleepiness was seen at all levels of RDI, with no significant change in the relation of snoring to ESS score after adjustment for RDI in multivariate models. The effects of snoring and RDI on sleepiness were little affected by adjustment for age, sex, race, body mass index, or questionnaire evidence of insufficient sleep time or nocturnal leg jerks or cramps. We conclude that both snoring and RDI are independently associated with excess sleepiness in community-dwelling, middle-aged and older adults.