Unique sleep-stage transitions determined by obstructive sleep apnea severity, age and gender.
exponential distribution
power-law distribution
sleep dynamics
sleep fragmentation
sleep-disordered breathing
Journal
Journal of sleep research
ISSN: 1365-2869
Titre abrégé: J Sleep Res
Pays: England
ID NLM: 9214441
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
30
03
2019
revised:
06
06
2019
accepted:
19
06
2019
pubmed:
28
7
2019
medline:
22
8
2020
entrez:
27
7
2019
Statut:
ppublish
Résumé
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.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e12895Investigateurs
P Steiropoulos
(P)
J Verbraecken
(J)
E Petiet
(E)
Georgia Trakada
(G)
J M Montserrat
(JM)
I Fietze
(I)
T Penzel
(T)
Ondrej Ludka
(O)
Daniel RodensteinCliniques
(D)
J F Masa
(JF)
I Bouloukaki
(I)
S Schiza
(S)
B Kent
(B)
W T McNicholas
(WT)
S Ryan
(S)
R L Riha
(RL)
J A Kvamme
(JA)
L Grote
(L)
J Hedner
(J)
J L Pépin
(JL)
S Bailly
(S)
Lena Lavie
(L)
Peretz Lavie
(P)
O K Basoglu
(OK)
M S Tasbakan
(MS)
G Varoneckas
(G)
P Joppa
(P)
R Tkacova
(R)
R Staats
(R)
F Barbé
(F)
C Lombardi
(C)
G Parati
(G)
Marta Drummond
(M)
Mafalda van Zeller
(M)
M R Bonsignore
(MR)
O Marrone
(O)
Informations de copyright
© 2019 European Sleep Research Society.
Références
Aho, A. V., Kernighan, B. W., & Weinberger, P. J. (1988). The AWK programming language. Boston, MA: Addison-Wesley. ISBN 9780201079814; see also wikipedia.org/wiki/AWK
AlGhanim, N., Comondore, V. R., Fleetham, J., Marra, C. A., & Ayas, N. T. (2008). The economic impact of obstructive sleep apnea. Lung, 186, 7-12. https://doi.org/10.1007/s00408-007-9055-5
Baguet, J. P., Hammer, L., Levy, P., Pierre, H., Rossini, E., Mouret, S., … Pepin, J. L. (2005). Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients. Journal of Hypertension, 23, 521-527.
Bianchi, M. T., Cash, S. S., Mietus, J., Peng, C. K., & Thomas, R. (2010). Obstructive sleep apnea alters sleep stage transition dynamics. PLoS ONE, 5, e11356. https://doi.org/10.1371/journal.pone.0011356
Bianchi, M. T., Eiseman, N. A., Cash, S. S., Mietus, J., Peng, C. K., & Thomas, R. J. (2012). Probabilistic sleep architecture models in patients with and without sleep apnea. Journal of Sleep Research, 21, 330-341. https://doi.org/10.1111/j.1365-2869.2011.00937.x
Chervin, R. D., & Aldrich, M. S. (1999). The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea. Neurology, 52, 125-131.
Chervin, R. D., Fetterolf, J. L., Ruzicka, D. L., Thelen, B. J., & Burns, J. W. (2009). Sleep stage dynamics differ between children with and without obstructive sleep apnea. Sleep, 32, 1325-1332.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic.
Danker-Hopfe, H., Kunz, D., Gruber, G., Klosch, G., Lorenzo, J. L., Himanen, S. L., … Dorffner, G. (2004). Interrater reliability between scorers from eight European sleep laboratories in subjects with different sleep disorders. Journal of Sleep Research, 13, 63-69.
Hedner, J., Grote, L., Bonsignore, M., McNicholas, W., Lavie, P., Parati, G., … Zielinski, J. (2011). European Sleep Apnoea Database (ESADA): Report from 22 European sleep laboratories. The European Respiratory Journal, 38, 635-642. https://doi.org/10.1183/09031936.00046710
Iber, C., Ancoli-Israel, S., Chesson, A., & Quan, S. (2007). The AASM Manual for the scoring of sleep and sssociated events: Rules, terminology and technical specifications, 1st edn. Westchester: American Academy of Sleep Medicine.
Kishi, A., Natelson, B. H., Togo, F., Struzik, Z. R., Rapoport, D. M., & Yamamoto, Y. (2011). Sleep-stage dynamics in patients with chronic fatigue syndrome with or without fibromyalgia. Sleep, 34, 1551-1560. https://doi.org/10.5665/sleep.1396
Laffan, A., Caffo, B., Swihart, B. J., & Punjabi, N. M. (2010). Utility of sleep stage transitions in assessing sleep continuity. Sleep, 33, 1681-1686.
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863. https://doi.org/10.3389/fpsyg.2013.00863
Lo, C. C., Bartsch, R. P., & Ivanov, P. C. (2013). Asymmetry and basic pathways in sleep-stage transitions. Europhysics Letters, 102, 10,008. https://doi.org/10.1209/0295-5075/102/10008
Lo, C. C., Chou, T., Penzel, T., Scammel, T. E., Strecker, R. E., Stanley, H. E., & Ivanov, P. C. (2004). Common scale-invariant patterns of sleep-wake transitions across mammalian species. Proceedings of the National Academy of Sciences of the United States of America, 101, 17,545-17,548. https://doi.org/10.1073/pnas.0408242101
Newman, M. E. J. (2005). Power laws, Pareto distributions and Zipf's law. Contemporary Physics, 46, 323-351. https://doi.org/10.1080/00107510500052444
Olejnik, S., & Algina, J. (2003). Generalized eta and omega squared statistics: Measures of effect size for some common research designs. Psychological Methods, 8, 434-447. https://doi.org/10.1037/1082-989x.8.4.434
Parati, G., Lombardi, I. C., & Narkiewicz, K. (2007). Sleep apnea: Epidemiology, pathophysiology, and relation to cardiovascular risk. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 293, R1671-R1683. https://doi.org/10.1152/ajpregu.00400.2007
Pataka, A., & Riha, R. L. (2009). The obstructive sleep apnoea/hypopnoea syndrome - An overview. Respiratory Medicine CME, 2, 111-117. https://doi.org/10.1016/j.rmedc.2009.03.001
Penzel, T., Behler, P. G., Von Buttlar, M., Conradt, R., Meier, M., Möller, A., & Danker-Hopfe, H. (2003). Reliability of visual evaluation of sleep stages according to Rechtschaffen and Kales from eight polysomnographs by nine sleep centres. Somnologie, 7, 49-58. https://doi.org/10.1046/j.1439-054x.2003.03199.x
Penzel, T., Lo, C. C., Ivanov, P., Kesper, K., Becker, H., & Vogelmeier, C. (2005). Analysis of sleep fragmentation and sleep structure in patients with sleep apnea and normal volunteers. Conference Proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference, 3, 2591-2594. https://doi.org/10.1109/iembs.2005.1616999
Pepin, J. L., Borel, A. L., Tamisier, R., Baguet, J. P., Levy, P., & Dauvilliers, Y. (2014). Hypertension and sleep: Overview of a tight relationship. Sleep Medicine Reviews, 18, 509-519. https://doi.org/10.1016/j.smrv.2014.03.003
Pizza, F., Vandi, S., Iloti, M., Franceschini, C., Liquori, R., Mignot, E., & Plazzi, G. (2015). Nocturnal sleep dynamics identify narcolepsy type 1. Sleep, 38, 1277-1284. https://doi.org/10.5665/sleep.4908
Porta, A., Baumert, M., Cysarz, D., & Wessel, N. (2015). Enhancing dynamical signatures of complex systems through symbolic computation. Philosophical Transactions. Series A, Mathematical, Physical, and Engineering Sciences, 373(203), 4. https://doi.org/10.1098/rsta.2014.0099
Redline, S., Kirchner, H. L., Quan, S. F., Gottlieb, D. J., Kapur, V., & Newman, A. (2004). The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Archives of Internal Medicine, 164, 406-418. https://doi.org/10.1001/archinte.164.4.406
Roure, N., Gomez, S., Mediano, O., Duran, J., Pena Mde, L., Capote, F., … Barbe, F. (2008). Daytime sleepiness and polysomnography in obstructive sleep apnea patients. Sleep Medicine, 9, 727-731. https://doi.org/10.1016/j.sleep.2008.02.006
Saper, C. B., Fuller, P. M., Pedersen, N. P., Lu, J., & Scammell, T. E. (2010). Sleep state switching. Neuron, 68, 1023-1042. https://doi.org/10.1016/j.neuron.2010.11.032
Schlemmer, A., Parlitz, U., Luther, S., Wessel, N., & Penzel, T. (2015). Changes of sleep-stage transitions due to ageing and sleep disorder. Philosophical Transactions. Series A, Mathematical, Physical, and Engineering Sciences, 373, 20140093. https://doi.org/10.1098/rsta.2014.0093
Swihart, B. J., Caffo, B., Bandeen-Roche, K., & Punjabi, N. M. (2008). Characterizing sleep structure using the hypnogram. Journal of Clinical Sleep Medicine, 4, 349-355.
Thompson, B. (2007). Effect sizes, confidence intervals, and confidence intervals for effect sizes. Psychology in the Schools, 44, 423-432. https://doi.org/10.1002/pits.20234
Wei, Y., Colombo, M. A., Ramautar, J. R., Blanken, T. F., van der Werf, Y. D., Spiegelhader, K., … Van Someren, E. J. W. (2017). Sleep stage transition dynamics reveal specific stage 2 vulnerability in insomnia. Sleep, 40, zsx17. https://doi.org/10.1093/sleep/zsx117
Wilson, S., & Argyropoulos, S. (2005). Antidepressants and sleep. Drugs, 65, 927-947. https://doi.org/10.2165/00003495-200565070-00003
Yilmaz, M. B., Erdem, A., Yalta, K., Turgut, O. O., Yilmaz, O. O., & Tandogan, I. (2008). Impact of beta-blockers on sleep in patients with mild hypertension: A randomized trial between nebivolol and metoprolol. Advances in Therapy, 25, 871-883. https://doi.org/10.1007/s12325-008-0087-x
Zhang, X., Kantelhardt, J. W., Dong, X. S., Krefting, D., Li, J., Yan, H., … Han, F. (2017). Nocturnal dynamics of sleep-wake transitions in patients with narcolepsy. Sleep, 40, zsw050. https://doi.org/10.1093/sleep/zsw050