Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

Samu Kainulainen; Brett Duce; Henri Korkalainen; Arie Oksenberg; Akseli Leino; Erna S. Arnardottir; Antti Kulkas; Sami Myllymaa; Juha Töyräs; Timo Leppänen

doi:10.1183/13993003.01849-2019

Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

Samu Kainulainen^*
, Brett Duce
, Henri Korkalainen
, Arie Oksenberg
, Akseli Leino
, Erna S. Arnardottir
, Antti Kulkas
, Sami Myllymaa
, Juha Töyräs
, Timo Leppänen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

60 Citations (Scopus)

Abstract

Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance. We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea-hypopnoea index (AHI) ≥5 events·h⁻¹). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression. A relative 10% increase in median depth of desaturations elevated the odds (OR_range 1.20-1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (OR_range 1.26-1.52, p<0.05) associated with prolonged median reaction time. Female sex (OR_range 2.21-6.02, p<0.01), Epworth Sleepiness Scale score (OR_range 1.05-1.07, p<0.01) and older age (OR_range 1.01-1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance. These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

Original language	English
Article number	1901849
Pages (from-to)	1901849
Journal	European Respiratory Journal
Volume	55
Issue number	4
DOIs	https://doi.org/10.1183/13993003.01849-2019
Publication status	Published - 2020
Publication type	A1 Journal article-refereed

Funding

Conflict of interest: S. Kainulainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041779 and 5041768), the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221, VTR3228 and EVO2089), Päivikki and Sakari Sohlberg Foundation and the Research Foundation of the Pulmonary Diseases, during the conduct of the study. B. Duce has nothing to disclose. H. Korkalainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041780 and 5041767), Respiratory Foundation of Kuopio Region, Päivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, Foundation of the Finnish Anti-Tuberculosis Association, during the conduct of the study. A. Oksenberg has nothing to disclose. A. Leino reports grants from the Research Committee of the Kuopio University Hospital Catchment Area (project number 5041776), Päivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, the Finnish Cultural Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. E.S. Arnardottir reports grants, personal fees and non-financial support from Nox Medical, personal fees from Philips and ResMed, outside the submitted work. A. Kulkas reports grants from Seinäjoki Central Hospital, Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (VTR3221 and VTR3228 and Tampere Tuberculosis foundation, during the conduct of the study. S. Myllymaa reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041770), Paulo Foundation and Tampere Tuberculosis Foundation, during the conduct of the study. J. Töyräs reports grants from Academy of Finland (decision number 313697), Kuopio University Hospital (project number 5041767) and Business Finland (decision number 5133/31/2018), during the conduct of the study. T. Leppänen reports grants from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project number 5041767), Academy of Finland (decision numbers 313697 and 323536), Tampere Tuberculosis Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. Support statement: During conduction of the present study, funding was received from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041768, 5041770, 5041776, 5041779 and 5041780), the Academy of Finland (decision numbers 313697 and 323536), Seinäjoki Central Hospital, the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221 and VTR3228), Business Finland (decision number 5133/31/2018), Paulo Foundation, Päivikki and Sakari Sohlberg Foundation, The Research Foundation of the Pulmonary Diseases, Finnish Cultural Foundation, Tampere Tuberculosis Foundation, Finnish Anti-Tuberculosis Foundation and the Respiratory Foundation of Kuopio Region. Funding information for this article has been deposited with the Crossref Funder Registry.

Publication forum classification

Publication forum level 3

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

Access to Document

10.1183/13993003.01849-2019Licence: CC BY-NC

https://pubmed.ncbi.nlm.nih.gov/32029446

Cite this

Kainulainen, S., Duce, B., Korkalainen, H., Oksenberg, A., Leino, A., Arnardottir, E. S., Kulkas, A., Myllymaa, S., Töyräs, J., & Leppänen, T. (2020). Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients. European Respiratory Journal, 55(4), 1901849. Article 1901849. https://doi.org/10.1183/13993003.01849-2019

@article{b1ae570f9c0c4748be6ba4c361582e1a,

title = "Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients",

abstract = "Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance. We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea-hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression. A relative 10\% increase in median depth of desaturations elevated the odds (ORrange 1.20-1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26-1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21-6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05-1.07, p<0.01) and older age (ORrange 1.01-1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance. These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.",

author = "Samu Kainulainen and Brett Duce and Henri Korkalainen and Arie Oksenberg and Akseli Leino and Arnardottir, \{Erna S.\} and Antti Kulkas and Sami Myllymaa and Juha T{\"o}yr{\"a}s and Timo Lepp{\"a}nen",

note = "Funding Information: Conflict of interest: S. Kainulainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041779 and 5041768), the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221, VTR3228 and EVO2089), P{\"a}ivikki and Sakari Sohlberg Foundation and the Research Foundation of the Pulmonary Diseases, during the conduct of the study. B. Duce has nothing to disclose. H. Korkalainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041780 and 5041767), Respiratory Foundation of Kuopio Region, P{\"a}ivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, Foundation of the Finnish Anti-Tuberculosis Association, during the conduct of the study. A. Oksenberg has nothing to disclose. A. Leino reports grants from the Research Committee of the Kuopio University Hospital Catchment Area (project number 5041776), P{\"a}ivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, the Finnish Cultural Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. E.S. Arnardottir reports grants, personal fees and non-financial support from Nox Medical, personal fees from Philips and ResMed, outside the submitted work. A. Kulkas reports grants from Sein{\"a}joki Central Hospital, Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (VTR3221 and VTR3228 and Tampere Tuberculosis foundation, during the conduct of the study. S. Myllymaa reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041770), Paulo Foundation and Tampere Tuberculosis Foundation, during the conduct of the study. J. T{\"o}yr{\"a}s reports grants from Academy of Finland (decision number 313697), Kuopio University Hospital (project number 5041767) and Business Finland (decision number 5133/31/2018), during the conduct of the study. T. Lepp{\"a}nen reports grants from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project number 5041767), Academy of Finland (decision numbers 313697 and 323536), Tampere Tuberculosis Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. Funding Information: Support statement: During conduction of the present study, funding was received from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041768, 5041770, 5041776, 5041779 and 5041780), the Academy of Finland (decision numbers 313697 and 323536), Sein{\"a}joki Central Hospital, the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221 and VTR3228), Business Finland (decision number 5133/31/2018), Paulo Foundation, P{\"a}ivikki and Sakari Sohlberg Foundation, The Research Foundation of the Pulmonary Diseases, Finnish Cultural Foundation, Tampere Tuberculosis Foundation, Finnish Anti-Tuberculosis Foundation and the Respiratory Foundation of Kuopio Region. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: Copyright {\textcopyright} ERS 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

doi = "10.1183/13993003.01849-2019",

language = "English",

volume = "55",

pages = "1901849",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

number = "4",

}

Kainulainen, S, Duce, B, Korkalainen, H, Oksenberg, A, Leino, A, Arnardottir, ES, Kulkas, A, Myllymaa, S, Töyräs, J & Leppänen, T 2020, 'Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients', European Respiratory Journal, vol. 55, no. 4, 1901849, pp. 1901849. https://doi.org/10.1183/13993003.01849-2019

TY - JOUR

T1 - Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

AU - Kainulainen, Samu

AU - Duce, Brett

AU - Korkalainen, Henri

AU - Oksenberg, Arie

AU - Leino, Akseli

AU - Arnardottir, Erna S.

AU - Kulkas, Antti

AU - Myllymaa, Sami

AU - Töyräs, Juha

AU - Leppänen, Timo

N1 - Funding Information: Conflict of interest: S. Kainulainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041779 and 5041768), the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221, VTR3228 and EVO2089), Päivikki and Sakari Sohlberg Foundation and the Research Foundation of the Pulmonary Diseases, during the conduct of the study. B. Duce has nothing to disclose. H. Korkalainen reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041780 and 5041767), Respiratory Foundation of Kuopio Region, Päivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, Foundation of the Finnish Anti-Tuberculosis Association, during the conduct of the study. A. Oksenberg has nothing to disclose. A. Leino reports grants from the Research Committee of the Kuopio University Hospital Catchment Area (project number 5041776), Päivikki and Sakari Sohlberg Foundation, the Research Foundation of the Pulmonary Diseases, the Finnish Cultural Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. E.S. Arnardottir reports grants, personal fees and non-financial support from Nox Medical, personal fees from Philips and ResMed, outside the submitted work. A. Kulkas reports grants from Seinäjoki Central Hospital, Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (VTR3221 and VTR3228 and Tampere Tuberculosis foundation, during the conduct of the study. S. Myllymaa reports grants from Academy of Finland (grant number 313697), the Research Committee of the Kuopio University Hospital Catchment Area (project numbers 5041770), Paulo Foundation and Tampere Tuberculosis Foundation, during the conduct of the study. J. Töyräs reports grants from Academy of Finland (decision number 313697), Kuopio University Hospital (project number 5041767) and Business Finland (decision number 5133/31/2018), during the conduct of the study. T. Leppänen reports grants from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project number 5041767), Academy of Finland (decision numbers 313697 and 323536), Tampere Tuberculosis Foundation and Respiratory Foundation of Kuopio Region, during the conduct of the study. Funding Information: Support statement: During conduction of the present study, funding was received from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041768, 5041770, 5041776, 5041779 and 5041780), the Academy of Finland (decision numbers 313697 and 323536), Seinäjoki Central Hospital, the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (grants VTR3221 and VTR3228), Business Finland (decision number 5133/31/2018), Paulo Foundation, Päivikki and Sakari Sohlberg Foundation, The Research Foundation of the Pulmonary Diseases, Finnish Cultural Foundation, Tampere Tuberculosis Foundation, Finnish Anti-Tuberculosis Foundation and the Respiratory Foundation of Kuopio Region. Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: Copyright © ERS 2020. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020

Y1 - 2020

N2 - Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance. We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea-hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression. A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20-1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26-1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21-6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05-1.07, p<0.01) and older age (ORrange 1.01-1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance. These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

AB - Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance. We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea-hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression. A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20-1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26-1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21-6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05-1.07, p<0.01) and older age (ORrange 1.01-1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance. These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

U2 - 10.1183/13993003.01849-2019

DO - 10.1183/13993003.01849-2019

M3 - Article

C2 - 32029446

SN - 0903-1936

VL - 55

SP - 1901849

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 4

M1 - 1901849

ER -

Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

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