Relating sleep disordered breathing to daytime function

描述（由申请人提供）：白天过度嗜睡（EDS）是患有阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的受试者最常见的主诉。这项研究的广泛的长期目标是研究生理压力，睡眠呼吸障碍（SDB），其相关的睡眠片段，其结果（白天嗜睡）之间的复杂关系。由于碎片化的常规测量与嗜睡测量之间的相关性较差，因此将使用用于识别阻塞性呼吸事件的最佳可用技术在多个夜晚评估SDB，并且将从检测到的事件中获得阻塞性指数（OI）。这些将与EDS相关，使用多种测量方法进行量化，包括心理警戒任务，多次睡眠潜伏期测试和主观嗜睡量表。这些关系将在经鼻持续气道正压通气（CPAP）监测治疗后的疑似OSAHS受试者和正常志愿者中进行评价。本研究的具体目的是具体目的1：评价我们的综合阻塞指数（OI）与未治疗受试者的嗜睡的相关性，这些受试者具有一系列严重的阻塞性睡眠呼吸障碍。在子分析中，将评价具有不同特征（例如，O2去饱和、EEG和自主觉醒、上气道阻力变化）的事件对EDS的相对贡献，以进一步细化OI，如果可以证明它们对EDS指数的预测能力有贡献的话。具体目标二：测试阻塞指数预测CPAP治疗后与SDB变化相关的嗜睡变化的效用。具体目标3：通过次优CPAP治疗实验性引入SDB，以证明SDB（使用OI）与EDS的“剂量-反应”关系。具体目标4：使用阻塞指数预测短暂停用CPAP诱导的SDB急性期后的嗜睡。定义这些关系不仅对我们理解这种疾病、诊断和治疗有意义，而且有助于更全面地了解睡眠和嗜睡之间的关系。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%的美国成年人口。白天过度嗜睡是这些患者的主要问题。本研究有助于了解睡眠呼吸暂停患者的嗜睡症状。验证与嗜睡相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.