0736 Self-reported Sleep In OSA Patients: Roles Of Polysomnographic Measures And Depressive Symptoms

Introduction

Sleep fragmentation is typical in OSA, which is commonly co-morbid with insomnia and depression. A complex interaction between these conditions may be also gender-dependent. Moreover, self-report measures of sleep quality and insomnia, such as PSQI and ISI, may relate to depression symptoms more than polysomnographic sleep disturbance. The present aim is to ascertain relative contributions of polysomnographic variables and depression symptoms to PSQI and ISI in a large sample of OSA patients. The interaction between depressive symptomatology and gender in their relationships with subjective sleep is also analyzed.

Methods

A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI and PSQI. ISI and PSQI were separately regressed onto age, sex and BMI, followed by PSG variables meeting p<0.1 criterion when tested individually, followed by CESDR and CESDR-by-sex interaction.

Results

Mean AHI=29.6±34.7, range 0-167/hr, 72.3% of patients had AHI≥5. The PSQI final model included total sleep time (TST), sleep efficiency (SEF), WASO, PLM index, CESDR and CESDR-by-sex. Only CESDR and CESDR-by-sex were significant (p<0.001, p=0.023, respectively). Higher CESDR predicted higher PSQI in both sexes (both p<0.001), accounting for a greater portion of PSQI variance in men (R2=39%) than in women (R2=29%). The ISI final model included TST, N3%, REM%, SEF, WASO, total arousal index, AHI, PLM index, CESDR and CESDR-by-sex. Higher ISI related to lower TST (p=0.042, R2<1%), higher REM% (p=0.016, R2<1%), and higher CESDR (p<0.001, R2=42%). CESDR-by-sex was not significant.

Conclusion

In this large sample, after controlling for demographic variables, PSG parameters had only minimal relationship with self-report insomnia and sleep quality measures. Higher depressive symptomatology was associated with higher subjective sleep disturbance on PSQI and worse insomnia symptoms on ISI in both sexes, accounting for 29-42% of the variance.

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0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures

Introduction

Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA.

Methods

A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p<0.1 criterion. AHI and SpO2nadir were forced into the models.

Results

Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2<1%), lower total arousal index (TAI, p=0.006, R2<1%), higher total sleep time (TST, p=0.003, R2<1%), higher PSQI (p<0.001, R2=5%), and higher CESD (p=0.001, R2<1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2<1%), lower TAI (p<0.001, R2=1%), higher PSQI (p<0.001, R2=3%, and higher CESD (p<0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men.

Conclusion

On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables.

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