Unique sleep‐stage transitions determined by obstructive sleep apnea severity, age and gender. (25th July 2019)

• Record Type: Journal Article
• Authors: Wächter, Marcel; Kantelhardt, Jan W.; Bonsignore, Maria R.; Bouloukaki, Izolde; Escourrou, Pierre; Fietze, Ingo; Grote, Ludger; Korzybski, Damian; Lombardi, Carolina; Marrone, Oreste; Paranicova, Ivana; Pataka, Athanasia; Ryan, Silke; Schiza, Sophia E.; Sliwinski, Pawel; Steiropoulos, Paschalis; Verbraecken, Johan; Penzel, Thomas
• Other Names: Steiropoulos P investigator.; Verbraecken J investigator.; Petiet E investigator.; Trakada Georgia investigator.; Montserrat JM investigator.; Fietze I investigator.; Penzel T investigator.; Ludka Ondrej investigator.; RodensteinCliniques Daniel investigator.; Masa JF investigator.; Bouloukaki I investigator.; Schiza S investigator.; Kent B investigator.; McNicholas WT investigator.; Ryan S investigator.; Riha RL investigator.; Kvamme JA investigator.; Grote L investigator.; Hedner J investigator.; Pépin JL investigator.; Bailly S investigator.; Lavie Lena investigator.; Lavie Peretz investigator.; Basoglu OK investigator.; Tasbakan MS investigator.; Varoneckas G investigator.; Joppa P investigator.; Tkacova R investigator.; Staats R investigator.; Barbé F investigator.; Lombardi C investigator.; Parati G investigator.; Drummond Marta investigator.; van Zeller Mafalda investigator.; Bonsignore MR investigator.; Marrone O investigator.;
• Is Part Of: Journal of sleep research. Volume 29:Number 2(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-07-25
• Subjects: exponential distribution -- power‐law distribution -- sleep dynamics -- sleep fragmentation -- sleep‐disordered breathing; Sleep -- Periodicals; Sleep disorders -- Periodicals; 612.821
• DOI: 10.1111/jsr.12895
• Languages: English
• ISSNs: 0962-1105

Abstract

Summary: In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild ( n = 209), moderate ( n = 222) and severe ( n = 272) obstructive sleep apnea patients as well as healthy controls ( n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake‐state durations followed a power‐law distribution, while sleep‐state durations were characterized by an exponential distribution. Sleep‐stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort ( n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea‐related clinical outcomes like arterial hypertension and daytime sleepiness.