TY - JOUR T1 - Severe desaturations increase PVT-based median reaction time and number of lapses in OSA patients JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01849-2019 SP - 1901849 AU - Samu Kainulainen AU - Brett Duce AU - Henri Korkalainen AU - Arie Oksenberg AU - Akseli Leino AU - Erna Arnardottir AU - Antti Kulkas AU - Sami Myllymaa AU - Juha Töyräs AU - Timo Leppänen Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/01/16/13993003.01849-2019.abstract N2 - Current diagnostic parameters estimating obstructive sleep apnea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apneas, hypopneas, and intermittent hypoxemia is associated with impaired vigilance.We retrospectively examined Type I polysomnography data and corresponding PVTs of 743 consecutive OSA patients (apnea-hypopnea index (AHI)≥5). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index, ODI) and novel parameters (e.g. Desaturation Severity and Obstruction Severity) incorporating duration of apneas and hypopneas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables utilising binomial logistic regression.A relative 10% increase in median depth of desaturations elevated the odds (ORrange=1.20–1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in Desaturation Severity (ORrange=1.26–1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange=2.21–6.02, p<0.01), ESS score (ORrange=1.05–1.07, p<0.01) and older age (ORrange=1.01–1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance.These results show that our novel parameters describing the severity of intermittent hypoxemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Kainulainen reports grants from Academy of Finland (grant number 313697), grants from The Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041779 and 5041768), grants from the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221, VTR3228, and EVO2089), grants from Päivikki & Sakari Sohlberg Foundation, grants from The Research Foundation of the Pulmonary Diseases, during the conduct of the study.Conflict of interest: Dr. Duce has nothing to disclose.Conflict of interest: Dr. Korkalainen reports grants from Academy of Finland (grant number 313697), grants from The Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041780 and 5041767), grants from Respiratory Foundation of Kuopio Region, grants from Päivikki & Sakari Sohlberg Foundation, grants from The Research Foundation of the Pulmonary Diseases, grants from Foundation of the Finnish Anti-Tuberculosis Association, during the conduct of the study.Conflict of interest: Dr. Oksenberg has nothing to disclose.Conflict of interest: Dr. Leino reports grants from The Research Committee of the Kuopio University Hospital Catchment Area (project number 5041776), grants from Päivikki & Sakari Sohlberg Foundation, grants from The Research Foundation of the Pulmonary Diseases, grants from The Finnish Cultural Foundation, grants from Respiratory Foundation of Kuopio Region, during the conduct of the study.Conflict of interest: Dr. Arnardottir reports grants, personal fees and non-financial support from Nox Medical, personal fees from Philips, personal fees from ResMed, outside the submitted work.Conflict of interest: Dr. Kulkas reports grants from Seinäjoki Central Hospital, Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (VTR3221 and VTR3228), grants from Tampere Tuberculosis foundation, during the conduct of the study.Conflict of interest: Dr. Myllymaa reports grants from Academy of Finland (grant number 313697), grants from The Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041770), grants from Paulo Foundation, grants from Tampere Tuberculosis Foundation, during the conduct of the study.Conflict of interest: Dr. Töyräs reports grants from Academy of Finland (decision number 313697), grants from Kuopio University Hospital (project number 5041767), grants from Business Finland (decision number 5133/31/2018), during the conduct of the study.Conflict of interest: Dr. Leppänen reports grants from The Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project number 5041767), grants from Academy of Finland (decision numbers 313697 and 323536), grants from Tampere Tuberculosis Foundation, grants from Respiratory Foundation of Kuopio Region, during the conduct of the study. ER -