Severe obstructive sleep apnea: Sleepy versus nonsleepy patients

OBJECTIVES/HYPOTHESIS: To compare demographic and polysomnographic data of sleepy versus nonsleepy severe obstructive sleep apnea (OSA) patients according to the Epworth Sleepiness Scale (ESS). STUDY DESIGN: Retrospective cohort. METHODS: Six hundred forty-four consecutive severe (apnea-hypopnea index AHI >or= 30) adult OSA patients who underwent a polysomnographic evaluation in our sleep disorders unit. ESS data were available in 569 (88.3%). Three hundred twenty-seven (57.5%) patients had ESS > 10. RESULTS: Sleepy severe OSA patients are slightly younger and more obese than nonsleepy patients. These sleepy patients have shorter sleep latency and lower percentage of slow wave sleep. They consistently show a higher AHI, both supine and lateral AHI, have a higher number of short arousals, and a higher arousal index. They also have higher snoring loudness in the supine and both lateral positions and a lower minimal SaO(2) in rapid eye movement and non-rapid eye movement sleep. After adjusting for confounders, a logistic regression model points to apnea index as a significant prognostic factor for excessive daytime sleepiness. CONCLUSIONS: Severe OSA sleepy patients have a syndrome that is significantly more severe than nonsleepy patients. Sleepy patients have worse sleep-related breathing parameters, and their sleep patterns are lighter and more fragmented than nonsleepy patients. Apnea index appears as an important prognostic factor for excessive daytime sleepiness.