Daytime sleepiness and polysomnographic variables in sleep apnoea patients

Excessive daytime sleepiness (EDS) is not invariably present in patients with obstructive sleep apnoea syndrome (OSAS). The aim of the present study was to investigate polysomnographic determinants of EDS in patients with OSAS. EDS was assessed using the Epworth Sleepiness Scale (ESS) and the multiple sleep latency test (MSLT). Patients showed EDS whenever the ESS score was >10 and the MSLT score <5 min. Absence of EDS was defined as having an ESS score of <10 and an MSLT score of >10 min. In total, 23 male patients with EDS (mean +/- SD ESS and MSLT score 17 +/- 3 and 4 +/- 1 min, respectively) and 17 without EDS (ESS and MSLT score 5 +/- 2 and 16 +/- 3 min, respectively), were studied. Both groups exhibited a similar apnoea/hypopnoea index (62 +/- 18 versus 60 +/- 20events center dot h(-1)). Patients with EDS exhibited shorter sleep latency (11 +/- 16 versus 18 +/- 18min) and greater sleep efficiency (90 +/- 7 versus 82 +/- 13%) than those without EDS. Patients with EDS showed lower oxygenation (lowest arterial oxygen saturation 69 +/- 12 versus 79 +/- 8%; mean arterial oxygen saturation 87 +/- 6 versus 90 +/- 5%). Sleep stage distribution and arousal index did not differ between the groups. Patients with obstructive sleep apnoea syndrome and excessive daytime sleepiness are characterised by shorter sleep latency, increased sleep efficiency and worse nocturnal oxygenation than those without excessive daytime sleepiness. Nocturnal hypoxaemia can be a major determinant of excessive daytime sleepiness in patients with obstructive sleep apnoea syndrome.