PUPILLOMETRIC SLEEPINESS IN TREATED SLEEP DISORDERS

阻塞性睡眠呼吸暂停和发作性睡病患者由于与这些疾病相关的病理性白天过度嗜睡（EDS），可能会经历生活质量下降、工作效率下降、工作场所和交通事故。目前，EDS的程度是通过多导睡眠图和多睡眠潜伏期测试（MSLT）来确定的，这两种基于脑电图的生理嗜睡测量是劳动密集型的，耗时，昂贵的，并且只能获得有限的医疗保险。当人们昏昏欲睡时，他们的瞳孔会大幅度摆动，缩小。在本研究中，我们将使用桌面瞳孔测量法计算瞳孔动荡指数（PUI）来评估睡意，这是一种高效、方便、无创且易于重复的技术。PUI定量描述了15分钟警觉性测试期间瞳孔振荡的程度。目前还没有将PUI与其他生理嗜睡指标进行比较的定量数据。这项重复测量的受试者队列，已知组方法学研究将包括正常对照，以及常规治疗前后的阻塞性睡眠呼吸暂停和发作性睡症受试者。具体目的是：(1)将PUI与被试组间的MSLT睡眠潜伏期联系起来；92)比较PUI和MSLT在三个被试组中检测嗜睡的效果；(3)比较各组之间以及OSA和发作性睡病患者常规治疗前后的PUI和MSLT与其他客观和主观嗜睡指标的差异。采用方差分析（MANOVA）检验各组间PUI与MSLT之间的线性关系，以及各组间感知嗜睡、睡眠量、睡眠质量和连续性、情绪和功能状态测量的差异，以及OSA和发作性睡病患者治疗前后的差异。将使用MSLT结果作为分类受试者的“金标准”来估计PUI在检测嗜睡方面的敏感性和特异性。MLR将用于估计PUI或MSLT与其他客观和主观嗜睡测量之间的关系。研究结果将为PUI作为一种可靠有效的客观结果测量方法提供证据，该方法可以衡量睡眠呼吸暂停和发作性睡症受试者在治疗前后的清醒倾向。

Patients with obstructive sleep apnea and narcolepsy can experience a diminished quality of life, decreased productivity, and workplace and traffic accidents due to the pathologic excessive daytime sleepiness (EDS) associated with these disorders. Currently, the extent of EDS is determined by polysomnography and the Multiple-Sleep Latency Test (MSLT), two EEG-based physiologic sleepiness measures that are labor intensive, time-consuming, expensive and receive limited health insurance coverage. As people become sleepy, their pupils oscillate widely and decrease in size. In this study, the Pupil Unrest Index (PUI) will be calculated to estimate sleepiness using desk top pupillometry, an efficient, convenient, non-invasive and easily repeatable technique. The PUI quantitatively describes the extent of pupillary oscillation during 15 minutes of alertness testing. Quantitative data comparing the PUI to other physiologic sleepiness measures are not available. The subject cohorts for this repeated measures, known groups methodologic study will consist of normal controls, and obstructive sleep apnea and narcolepsy subjects before and after usual treatment. The specific aims are to (1) correlate the PUI with MSLT sleep latencies among the subject groups; 92) compare the PUI to the MSLT in detecting sleepiness among the three subject groups; and (3) compare the PUI and the MSLT to other objective and subjective sleepiness measures between subject groups, and before and after usual treatment among the OSA and narcolepsy subjects. MANOVA will be used to examine the linear relationship between the PUI and the MSLT among the subject groups, and the differences in measures of perceived sleepiness, sleep quantity, sleep quality and continuity, mood and functional status between the subject groups, and pre-post-treatment fore subjects with OSA and narcolepsy. The sensitivity and specificity of the PUI in detecting sleepiness will be estimated using the MSLT results as the "gold standard" for classifying subjects. MLR will be used to estimate the relationship between the PUI or the MSLT, and other objective and subjective sleepiness measures. Results will provide evidence about the PUI as a reliable and valid objective outcome measure of waking tendency among controls, and pre-post-treatment for OSA and narcolepsy subjects.