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The role of non-respiratory arousals in residual daytime sleepiness in patients with obstructive sleep apnea treated with positive airway pressure: An analysis of the European Sleep Apnea Database registry

A. Kalkanis, D. Papadopoulos, S. Schiza, H. Hein, A. Pataka, R. Riha, F. Fanfulla, H. Gouveris, J. Bušková, S. Mihaicuta, W. Randerath, JL. Pépin, L. Grote, D. Testelmans, European Sleep Apnea Database (ESADA) collaborators

. 2025 ; 127 (-) : 145-151. [pub] 20250121

Jazyk angličtina Země Nizozemsko

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc25009665

STUDY OBJECTIVES: To assess the impact of the non-respiratory arousal burden at baseline polysomnography (PSG) on residual daytime sleepiness in positive airway pressure (PAP)-treated obstructive sleep apnea (OSA). METHODS: We included OSA patients from the European Sleep Apnea Database registry with available arousal data who had at least 2 treatment follow-up visits. The primary outcome was the Epworth Sleepiness Scale (ESS) score under PAP. The non-respiratory arousal ratio (NRAR) was defined as the ratio of non-respiratory to total arousals at baseline PSG. A linear mixed model tested the effect of NRAR tertiles on residual sleepiness. Baseline variables that differed significantly between groups were included as covariates. RESULTS: 800 patients with OSA (69.6 % male, mean age 57.1 ± 12.0 years, mean NRAR 0.22 ± 0.20) were evaluated during three follow up visits at a mean of 197.4, 499.3, and 731.6 days after PAP initiation. The interaction between time and NRAR tertile was statistically significant (F = 4.55, p = 0.001). The lowest NRAR tertile was associated with lower residual sleepiness over time compared to the highest NRAR tertile. The associations were independent of sex, comorbidities, body mass index, blood pressure, baseline apnea-hypopnea index, and baseline ESS score. CONCLUSIONS: NRAR at baseline PSG predicts residual sleepiness in PAP-treated OSA patients. The findings offer new insights into OSA phenotyping and have important implications for patient care.

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$a Kalkanis, Alexandros $u Department of Pulmonology, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium. Electronic address: alexandros.kalkanis@uzleuven.be
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$a The role of non-respiratory arousals in residual daytime sleepiness in patients with obstructive sleep apnea treated with positive airway pressure: An analysis of the European Sleep Apnea Database registry / $c A. Kalkanis, D. Papadopoulos, S. Schiza, H. Hein, A. Pataka, R. Riha, F. Fanfulla, H. Gouveris, J. Bušková, S. Mihaicuta, W. Randerath, JL. Pépin, L. Grote, D. Testelmans, European Sleep Apnea Database (ESADA) collaborators
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$a STUDY OBJECTIVES: To assess the impact of the non-respiratory arousal burden at baseline polysomnography (PSG) on residual daytime sleepiness in positive airway pressure (PAP)-treated obstructive sleep apnea (OSA). METHODS: We included OSA patients from the European Sleep Apnea Database registry with available arousal data who had at least 2 treatment follow-up visits. The primary outcome was the Epworth Sleepiness Scale (ESS) score under PAP. The non-respiratory arousal ratio (NRAR) was defined as the ratio of non-respiratory to total arousals at baseline PSG. A linear mixed model tested the effect of NRAR tertiles on residual sleepiness. Baseline variables that differed significantly between groups were included as covariates. RESULTS: 800 patients with OSA (69.6 % male, mean age 57.1 ± 12.0 years, mean NRAR 0.22 ± 0.20) were evaluated during three follow up visits at a mean of 197.4, 499.3, and 731.6 days after PAP initiation. The interaction between time and NRAR tertile was statistically significant (F = 4.55, p = 0.001). The lowest NRAR tertile was associated with lower residual sleepiness over time compared to the highest NRAR tertile. The associations were independent of sex, comorbidities, body mass index, blood pressure, baseline apnea-hypopnea index, and baseline ESS score. CONCLUSIONS: NRAR at baseline PSG predicts residual sleepiness in PAP-treated OSA patients. The findings offer new insights into OSA phenotyping and have important implications for patient care.
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$a Papadopoulos, Dimitrios $u Department of Pulmonology, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium
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$a Schiza, Sophia $u Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
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$a Hein, Holger $u Sleep Disorders Center, Reinbek, Germany
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$a Pataka, Athanasia $u Respiratory Failure Unit, G. Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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$a Riha, Renata $u Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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$a Fanfulla, Francesco $u Sleep Medicine Unit, Institute Clinic Scientific Maugeri, IRCCS, Scientific Institute of Pavia, Pavia, Italy
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$a Gouveris, Haralampos $u Sleep Medicine and Neurostimulation Center, Department of Otorhinolaryngology, University Medical Center, Mainz, Germany
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$a Bušková, Jitka $u Department of Sleep Medicine, National Institute of Mental Health, Klecany, Czech Republic
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$a Mihaicuta, Stefan $u Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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$a Randerath, Winfried $u Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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$a Pépin, Jean-Louis $u Grenoble Alpes University, Inserm U1300, CHU Grenoble Alpes, HP2, Grenoble, France
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$a Grote, Ludger $u Sahlgrenska University Hospital, Department of Pulmonary Medicine, Center for Sleep and Wake Disorders, Gothenburg, Sweden
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$a Testelmans, Dries $u Department of Pulmonology, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium
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