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Mechanism of Excessive Wake Time When Associated with Obstructive Apnea and/or Periodic Limb Movements.

STUDY OBJECTIVES
It is uncertain if obstructive apnea (OSA) or periodic-limb-movements (PLMs) contribute to excessive-wake-time (EWT) when EWT and these disorders coexist. We hypothesized that such EWT is an independent disorder related to central regulation of sleep depth. Accordingly, we compared sleep depth in patients with EWT and OSA/PLMs (EWT+P) with patients with EWT and no OSA/PLMs (EWT-NP) and patients with normal-wake-time.


METHODS
267 subjects were divided into five groups: 1) EWT+P: n=100 (wake time >20% total recording time; TRT) with OSA (AHI 5-110 hr-1) and/or PLMs (index 10-151 hr-1); 2) EWT-NP: n=49 (wake time >20%TRT), no associated pathology; 3) NWT+P: n=54 (Wake time <20%TRT, with OSA/PLMs); 4) NWT-NP: n=26; 5) Normal subjects: n=38 (no sleep complaints, NWT and no OSA/PLMs). Sleep depth was evaluated by the odds-ratio-product (ORP; 0 =deep sleep, 2.5=fully alert). We also measured ORP in the 9 seconds immediately following arousals (ORP-9) to distinguish between peripheral and central mechanisms of light sleep.


RESULTS
ORP during sleep was higher (lighter sleep) in both EWT groups than in the three NWT groups (p<1E-11) with no difference between those with and those without OSA/PLMs. ORP-9 was also significantly higher in the EWT groups than in the NWT groups (p<1E-19), also with no difference between those with and without OSA/PLMs, indicating that the lighter sleep was of central origin. There were highly significant correlations between wake time and ORP-9 across all groups (p<1E-35).


CONCLUSIONS
Excessive wake time associated with OSA/PLMs is independent of OSA/PLMs and related to abnormal central regulation of sleep depth.