Relating sleep disordered breathing to daytime function

描述（由申请人提供）：白天过度嗜睡（EDS）是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者最常见的主诉。本研究的长期目标是研究生理应激、睡眠呼吸障碍（SDB）及其相关的睡眠碎片化及其结果（白天嗜睡）之间的复杂关系。由于传统的碎片测量和困倦测量之间的相关性很差，SDB将在多个晚上进行评估，使用现有的最佳技术来识别阻塞性呼吸事件，并采用一种新的测量方法，即从检测到的事件中获得阻塞性指数（Ol）。这些将与EDS相关，使用多种测量方法进行量化，包括精神运动警觉性任务、多重睡眠潜伏期测试和主观嗜睡量表。这些关系将在疑似OSAHS的受试者和正常志愿者中进行评估，这些受试者在接受鼻腔持续气道正压通气（CPAP）监测治疗后。该研究的具体目的是：评估我们的综合阻塞指数（Ol）与未治疗的具有一系列阻塞性睡眠呼吸障碍严重程度的受试者嗜睡的相关性。在亚分析中，如果能够证明具有不同特征的事件（如O2去饱和、脑电图和自主神经觉醒、上呼吸道阻力变化）对EDS的相对贡献有助于EDS指数的额外预测能力，则将评估其对EDS的相对贡献，以进一步完善Ol。具体目的2：测试梗阻指数在预测CPAP治疗后与SDB变化相关的嗜睡变化中的效用。具体目标3：通过次优CPAP治疗实验引入SDB，以证明SDB（使用Ol）与EDS的“剂量-反应”关系。具体目标4：使用梗阻指数预测短暂停药引起的急性SDB后的嗜睡。确定这些关系不仅对我们对这种疾病的理解、诊断和治疗有意义，而且有助于更全面地了解睡眠和困倦之间的关系。公共卫生相关性：阻塞性睡眠呼吸暂停/低通气综合征影响2-4%的美国成年人。白天过度嗜睡是这些患者的主要问题。本研究有助于理解睡眠呼吸暂停患者的这些嗜睡症状。验证与嗜睡有关的睡眠呼吸障碍的测量将有助于改善阻塞性睡眠呼吸暂停的诊断和治疗。

DESCRIPTION (provided by applicant): Excessive daytime sleepiness (EDS), is the most common complaint of subjects suffering from obstructive sleep apnea hypopnea syndrome (OSAHS). The broad long term objective of this research is to examine the complex relationship between the physiological stress, sleep disordered breathing (SDB), its associated sleep fragmentation, and its outcome (daytime sleepiness). Because correlations between conventional measures of fragmentation and measures of sleepiness have been poor, SDB will be assessed over multiple nights using the best available technology for identifying obstructive respiratory events and a novel measure, the obstructive index (Ol) will be obtained from the events detected. These will be related to EDS, quantified using multiple measures including the psychomotor vigilance task, the Multiple Sleep Latency Test and subjective scales of sleepiness. These relationships will be evaluated in subjects with suspected OSAHS following monitored treatment with nasal Continuous Positive airway Pressure (CPAP) and in normal volunteers. The specific aims of the study are Specific Aim 1: Evaluate the correlation of our integrated Obstruction Index (Ol) to sleepiness in untreated subjects with a range of severity of obstructive sleep disordered breathing. In a subanalysis, the relative contributions to EDS of events with different characteristics (eg O2 desaturation, EEG and autonomic arousal, changes in upper airway resistance) will be evaluated to further refine the Ol if it can be shown they contribute additional predictive power of the index for EDS. Specific Aim 2: Test the utility of the Obstruction Index to predict changes in sleepiness associated with changes in SDB following treatment with CPAP. Specific Aim 3: Experimentally introduce SDB through suboptimal CPAP therapy to demonstrate a "dose-response" relationship of SDB (using the Ol) to EDS. Specific Aim 4: Use the Obstruction Index to predict sleepiness following an acute period of SDB induced by a brief withdrawal of CPAP. Defining these relationships not only has implications for our understanding of this disease, its diagnosis and treatment, but also contributes to a more general understanding of the relationship between sleep and sleepiness. Public Health Relevance: Obstructive sleep apnea/hypopnea syndrome affects 2-4% of the adult U.S. population. Excessive daytime sleepiness is the primary problem in these patients. The present study contributes to understanding these symptoms of sleepiness in patients with sleep apnea. Validating a measure of sleep disordered breathing that relates to sleepiness will help improve the diagnosis and treatment of obstructive sleep apnea.