AUTHOR=Frangopoulos Frangiskos , Zannetos Savvas , Nicolaou Ivi , Economou Nicholas-Tiberio , Adamide Tonia , Georgiou Andreas , Nikolaidis Pantelis T. , Rosemann Thomas , Knechtle Beat , Trakada Georgia 

TITLE=The Complex Interaction Between the Major Sleep Symptoms, the Severity of Obstructive Sleep Apnea, and Sleep Quality

JOURNAL=Frontiers in Psychiatry

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.630162

DOI=10.3389/fpsyt.2021.630162

ISSN=1664-0640

ABSTRACT=<p><bold>Introduction:</bold> Little information exists in the general population whether clinical presentation phenotypes of obstructive sleep apnea (OSA) differ in terms of sleep quality and comorbidities.</p><p><bold>Aim:</bold> The purpose of our study was to assess possible differences between symptomatic and asymptomatic OSA patients concerning syndrome's severity, patients' sleep quality, and comorbidities.</p><p><bold>Subjects and methods:</bold> First, in a nationwide, stratified, epidemiological survey, 4,118 Cypriot adult participants were interviewed about sleep habits and complaints. In the second stage of the survey, 264 randomly selected adults underwent a type III sleep study for possible OSA. Additionally, they completed the Greek version of Pittsburgh Sleep Quality Index (Gr-PSQI), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Hospital Anxiety and Depression Scale (HADS).</p><p><bold>Results:</bold> From 264 enrolled participants, 155 individuals (40 females and 115 males) were first diagnosed with OSA. Among these 155 patients, 34% had ESS ≥ 10 and 49% AIS ≥ 6. One or both symptoms present categorized the individual as symptomatic (60%) and neither major symptom as asymptomatic (40%). There were no significant statistical differences (SSDs) between the two groups (symptomatic–asymptomatic) with regard to anthropometrics [age or gender; neck, abdomen, and hip circumferences; and body mass index (BMI)]. The two groups had no differences in OSA severity—as expressed by apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and mean oxyhemoglobin saturation (SaO<sub>2</sub>)—and in cardiometabolic comorbidities. Symptomatic patients expressed anxiety and depression more often than asymptomatics (<italic>p</italic> &lt; 0.001) and had poorer subjective sleep quality (Gr-PSQI, <italic>p</italic> &lt; 0.001). According to PSQI questionnaire, there were no SSDs regarding hours in bed and the use of sleep medications, but there were significant differences in the subjective perception of sleep quality (<italic>p</italic> &lt; 0.001), sleep efficiency (<italic>p</italic> &lt; 0.001), duration of sleep (<italic>p</italic> = 0.001), sleep latency (<italic>p</italic> = 0.007), daytime dysfunction (<italic>p</italic> &lt; 0.001), and finally sleep disturbances (<italic>p</italic> &lt; 0.001).</p><p><bold>Conclusion:</bold> According to our data, OSA patients reporting insomnia-like symptoms and/or sleepiness do not represent a more severe phenotype, by the classic definition of OSA, but their subjective sleep quality is compromised, causing a vicious cycle of anxiety or depression.</p>