Original articleSlow wave sleep rebound and REM rebound following the first night of treatment with CPAP for sleep apnea: correlation with subjective improvement in sleep quality☆
Introduction
Continuous positive airway pressure (CPAP) therapy is a commonly used method of treatment for patients with obstructive sleep apnea syndrome (OSAS). Patients routinely undergo an initial diagnostic overnight polysomnogram (dPSG) to determine the severity of the apnea. The dPSG, depending on the severity of OSAS, typically demonstrates recurrent apneas, hypopneas and oxygen desaturations with accompanying arousals. Compared to normal controls and depending on the severity of apnea, the patients spend a majority of the night in lighter stages of sleep (stages 1 and slow wave sleep) with little or no REM sleep. This is a reflection of the sleep fragmentation seen in individuals with OSAS and is considered to be the cause of excessive daytime sleepiness and poor daytime functioning. This is followed by a CPAP titration study (cpapPSG) to determine the optimal CPAP pressure and response to treatment. Following therapy with CPAP, there is a reduction of sleep latency, percentage of stage 1 sleep, arousal index (Al) and respiratory disturbance index (RDI), and increase in percentages of stage 2 sleep, REM sleep and an increase in frequency of eye movements during REM [1], [2]. Although most patients report subjective improvement in sleep quality after the CPAP titration study, many do not. No data exists on the differences between these two groups of patients. The purpose of this study was to compare changes in dPSG and cpapPSG parameters in patients who noted an improvement in sleep quality compared to those who did not. We hypothesized that patients reporting an improvement in sleep quality would exhibit less fragmentation, and therefore better restoration of their sleep stages, following CPAP than those reporting no improvement.
Section snippets
Subjects
We reviewed polysomnography reports of all patients (age>l7 years) that presented to the Duke Sleep Disorders Center for evaluation of OSAS. Only those patients who had two separate studies (dPSG and cpapPSG) performed at our center were considered for enrollment. These patients were diagnosed with OSAS based on the dPSG and only those patients who had a RDI>10 were eligible for this study. Patients with a movement arousal index>5 (with no other evidence of sleep apnea) and those with
Patient characteristics
A total of 44 (M/F=36/8; mean age: 51.6 years) patients were enrolled. The mean interval between the dPSG and the cpapPSG was 47 days. Thirty-four patients (M/F: 28/6) noted subjective improvement in sleep quality with CPAP (Group 1; mean patient score changed from 4.3–7.7) and ten patients (M/F: 7/3) did not note an improvement (Group 2; mean patient score changed from 6.65–5.6). The patients who felt subjective improvement were younger (48.9±12.6 years) compared to patients who did not note
Discussion
Overnight PSG studies in patients with OSAS usually demonstrate sleep disruption by frequent obstructive respiratory events (apneas and hypopneas) and arousals [9]. The result is non-restorative sleep and daytime hypersomnolence. In addition to cardiopulmonary disease, other complications of OSAS include depression, memory deficits, nocturnal panic disorder and chronic fatigue [10], [11], [12], [13], [14]. Treatment options were initially limited to surgery and attempting to eliminate
Acknowledgments
We would like to thank Sharon L. Elliott, R.EP T. and Laura Neil, R.PSG T. for their technical expertise.
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Presented at the 12th Annual APSS Meeting in New Orleans in June 1998.