Cyclic Alternating Pattern in Obstructive Sleep Apnea Patients with versus without Excessive Sleepiness

Abstract

Background. One of the main hypotheses on the development of daytime sleepiness (ES) is increased arousal in obstructive sleep apnea (OSA). Cyclic alternating pattern (CAP) is considered to be the main expression of sleep microstructure rather than arousal. Therefore, we aimed to investigate whether there is any difference between OSA patients with versus without ES in terms of the parameters of sleep macro- and microstructure and which variables are associated with Epworth Sleepiness Scale (ESS) score. Methods. Thirty-eight male patients with moderate to severe OSA were divided into two subgroups by having been used to ESS as ES or non-ES. Results. There was no difference between two groups in clinical characteristics and macrostructure parameters of sleep. However, ES group had significantly higher CAP rate, CAP duration, number of CAP cycles, and duration and rate of the subtypes A2 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.033</mml:mn></mml:math>, 0.019, 0.013, and 0.019, respectively) and lower mean phase B duration<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mo stretchy="false">(</mml:mo><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.028</mml:mn><mml:mo stretchy="false">)</mml:mo></mml:math>compared with non-ES group. In correlation analysis, ESS score was not correlated with any CAP measure. Conclusions. OSA patients with ES have increased CAP measures rather than those without ES.