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The role of mean inspiratory effort on daytime sleepiness

Sleep Disorders Unit, Dept of Neurology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey

CORRESPONDENCE: Z. Pelin, Bayar cad. 71/9, 81090, Kozyatagi, Istanbul, Turkey. Fax: 90 2163698925. E-mail: kzpelin@turk.net

Keywords: daytime sleepiness, respiratory effort, sleep apnoea syndrome, upper airway resistance

Received: November 28, 2001
Accepted October 1, 2002

This study has investigated the role of average maximum inspiratory effort in excessive daytime sleepiness in patients with obstructive sleep apnoea syndrome (OSAS) and upper airway resistance syndrome (UARS).

Fifteen patients diagnosed with UARS and 32 patients with OSAS, with >5.5 h total sleep time (TST) during 8 h of nocturnal polygraphic recordings, were included in the study. Demographical data, polysomnographical data and data about daytime sleepiness, including Epworth sleepiness scale (ESS) and multiple sleep latency test (MSLT), were evaluated. In order to compute the average maximum inspiratory effort from oesophageal pressure (P_oes) measurements, maximum P_oes was obtained from 20 representative obstructive respiratory events (obstructive apnoeas, hypopnoeas or flow limitations) for each sleep stage in both supine and side positions. From P_oes measurements during sleep, the increase in P_oes (P_oes) during respiratory events was also calculated.

The average maximum P_oes, P_oes, respiratory disturbance index (RDI) and arousal index were significantly correlated with ESS in OSAS patients. In patients with UARS, the only significant correlation was obtained between average maximum P_oes and ESS. The MSLT score did not show any significant correlation with arousal index, number of stage variations, RDI, average P_oes, P_oes, minimum oxygen saturation (S_a,O2) and percentage of TST with an S_a,O2 <90% in both UARS and OSAS patients. The results of multiple regression analysis showed that average maximum P_oes correlates best with the variance in ESS for OSAS patients.

In conclusion, the data from this study indicate the possible important role of average inspiratory effort in determining subjective sleepiness in both obstructive sleep apnoea syndrome and upper airway resistance syndrome patients.

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