Sleep time and efficiency in patients undergoing laboratory-based polysomnography

Elizabeth I Harrison, Robert H Roth, Jennifer M Lobo, Hyojung Kang, Jeongok Logan, Sanjay R Patel, Vishesh K Kapur, Younghoon Kwon, Elizabeth I Harrison, Robert H Roth, Jennifer M Lobo, Hyojung Kang, Jeongok Logan, Sanjay R Patel, Vishesh K Kapur, Younghoon Kwon

Abstract

Study objectives: Sleep quality in patients studied with laboratory-based polysomnography may differ from sleep quality in patients studied at home but remains clinically relevant and important to describe. We assessed objective sleep quality and explored factors associated with poor sleep in patients undergoing laboratory-based polysomnography.

Methods: We reviewed diagnostic polysomnography studies from a 10-year period at a single sleep center. Total sleep time (TST) and sleep efficiency (SE) were assessed as markers of sleep quality. Poor sleep was defined as TST ≤ 4 hours or SE ≤ 50%. Multivariable analysis was performed to determine associations between objective sleep quality as an outcome and multiple candidate predictors including age, sex, race, body mass index, comorbidities, severity of obstructive sleep apnea, and central nervous system medications.

Results: Among 4957 patients (age 53 ± 15 years), average TST and median SE were 5.8 hours and 79%, respectively. There were 556 (11%) and 406 (8%) patients who had poor sleep based on TST and SE, respectively. In multivariable analysis, those who were older (per 10 years: 1.48 [1.34, 1.63]), male (1.38 [1.14,1.68]), and had severe obstructive sleep apnea (1.76 [1.28, 2.43]) were more likely to have short sleep. Antidepressant use was associated with lower odds of short sleep (0.77 [0.59,1.00]). Older age (per 10 years: 1.48 [1.34, 1.62]), male sex (1.34 [1.07,1.68]), and severe obstructive sleep apnea (2.16 [1.47, 3.21]) were associated with higher odds of poor SE.

Conclusions: We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based polysomnography.

Citation: Harrison EI, Roth RH, Lobo JM, et al. Sleep time and efficiency in patients undergoing laboratory-based polysomnography. J Clin Sleep Med. 2021;17(8):1591-1598.

Keywords: polysomnography; sleep; sleep quality.

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. Patient inclusion and exclusion.
Figure 1. Patient inclusion and exclusion.
Figure 2. Distribution of total sleep time…
Figure 2. Distribution of total sleep time and sleep efficiency.
IQR = interquartile range.

References

    1. Kapur VK , Auckley DH , Chowdhuri S , et al. . Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline . J Clin Sleep Med . 2017. ; 13 ( 3 ): 479 – 504 .
    1. Schmidt HS , Kaelbling R . The differential laboratory adaptation of sleep parameters . Biol Psychiatry . 1971. ; 3 ( 1 ): 33 – 45 .
    1. Edinger JD , Fins AI , Sullivan RJ Jr , et al. . Sleep in the laboratory and sleep at home: comparisons of older insomniacs and normal sleepers . Sleep . 1997. ; 20 ( 12 ): 1119 – 1126 .
    1. Mendels J , Hawkins DR . Sleep laboratory adaptation in normal subjects and depressed patients (“first night effect”) . Electroencephalogr Clin Neurophysiol . 1967. ; 22 ( 6 ): 556 – 558 .
    1. Hauri PJ , Olmstead EM . Reverse first night effect in insomnia . Sleep . 1989. ; 12 ( 2 ): 97 – 105 .
    1. Riedel BW , Winfield CF , Lichstein KL . First night effect and reverse first night effect in older adults with primary insomnia: does anxiety play a role? Sleep Med . 2001. ; 2 ( 2 ): 125 – 133 .
    1. American Academy of Sleep Medicine. AASM Clarifies Hypopnea Scoring Criteria. .
    1. Berry RB , Budhiraja R , Gottlieb DJ , et al. ; Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine . Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events . J Clin Sleep Med . 2012. ; 8 ( 5 ): 597 – 619 .
    1. Zhang L , Zhao ZX . Objective and subjective measures for sleep disorders . Neurosci Bull . 2007. ; 23 ( 4 ): 236 – 240 .
    1. Keklund G , Akerstedt T . Objective components of individual differences in subjective sleep quality . J Sleep Res . 1997. ; 6 ( 4 ): 217 – 220 .
    1. Jolliffe IT , Cadima J . Principal component analysis: a review and recent developments . Philos Trans A Math Phys Eng Sci . 2016. ; 374 ( 2065 ): 20150202 .
    1. Wold S , Esbensen K , Geladi P . Principal component analysis . Chemom Intell Lab Syst . 1987. ; 2 ( 1-3 ): 37 – 52 .
    1. Elixhauser A , Steiner C , Harris DR , Coffey RM . Comorbidity measures for use with administrative data . Med Care . 1998. ; 36 ( 1 ): 8 – 27 .
    1. Fang H , Tu S , Sheng J , Shao A . Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment . J Cell Mol Med . 2019. ; 23 ( 4 ): 2324 – 2332 .
    1. Silva GE , Goodwin JL , Sherrill DL , et al. . Relationship between reported and measured sleep times: the Sleep Heart Health Study (SHHS) . J Clin Sleep Med . 2007. ; 3 ( 6 ): 622 – 630 .
    1. Redline S , Kirchner HL , Quan SF , Gottlieb DJ , Kapur V , Newman A . The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture . Arch Intern Med . 2004. ; 164 ( 4 ): 406 – 418 .
    1. Kwon Y , Gadi S , Shah NR , et al. . Atrial fibrillation and objective sleep quality by slow wave sleep . J Atr Fibrillation . 2018. ; 11 ( 2 ): 2031 .
    1. Blackwell T , Redline S , Ancoli-Israel S , et al. ; Study of Osteoporotic Fractures Research Group . Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study . Sleep . 2008. ; 31 ( 2 ): 283 – 291 .
    1. Iber C , Redline S , Kaplan Gilpin AM , et al. . Polysomnography performed in the unattended home versus the attended laboratory setting—Sleep Heart Health Study methodology . Sleep . 2004. ; 27 ( 3 ): 536 – 540 .
    1. Mitterling T , Högl B , Schönwald SV , et al. . Sleep and respiration in 100 healthy Caucasian sleepers: a polysomnographic study according to American Academy of Sleep Medicine standards . Sleep . 2015. ; 38 ( 6 ): 867 – 875 .
    1. Hertenstein E , Gabryelska A , Spiegelhalder K , et al. . Reference data for polysomnography-measured and subjective sleep in healthy adults . J Clin Sleep Med . 2018. ; 14 ( 4 ): 523 – 532 .
    1. Bruyneel M , Sanida C , Art G , et al. . Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography . J Sleep Res . 2011. ; 20 ( 1 Pt 2 ): 201 – 206 .
    1. Genuardi MV , Ogilvie RP , Saand AR , et al. . Association of short sleep duration and atrial fibrillation . Chest . 2019. ; 156 ( 3 ): 544 – 552 .
    1. Albuquerque FN , Calvin AD , Sert Kuniyoshi FH , et al. . Sleep-disordered breathing and excessive daytime sleepiness in patients with atrial fibrillation . Chest . 2012. ; 141 ( 4 ): 967 – 973 .
    1. Orff HJ , Meliska CJ , Lopez A , Martinez F , Sorenson D , Parry BL . Polysomnographic evaluation of sleep quality and quantitative variables in women as a function of mood, reproductive status, and age . Dialogues Clin Neurosci . 2012. ; 14 ( 4 ): 413 – 424 .
    1. Li J , Vitiello MV , Gooneratne NS . Sleep in normal aging . Sleep Med Clin . 2018. ; 13 ( 1 ): 1 – 11 .
    1. Unruh ML , Redline S , An MW , et al. . Subjective and objective sleep quality and aging in the sleep heart health study . J Am Geriatr Soc . 2008. ; 56 ( 7 ): 1218 – 1227 .
    1. Didikoglu A , Maharani A , Tampubolon G , Canal MM , Payton A , Pendleton N . Longitudinal sleep efficiency in the elderly and its association with health . J Sleep Res . 2020. ; 29 ( 3 ): e12898 .
    1. Ohayon MM , Carskadon MA , Guilleminault C , Vitiello MV . Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan . Sleep . 2004. ; 27 ( 7 ): 1255 – 1273 .
    1. Lauderdale DS , Knutson KL , Yan LL , et al. . Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study . Am J Epidemiol . 2006. ; 164 ( 1 ): 5 – 16 .
    1. Burgard SA , Ailshire JA . Gender and time for sleep among U.S. adults . Am Sociol Rev . 2013. ; 78 ( 1 ): 51 – 69 .
    1. Vitiello MV , Larsen LH , Moe KE . Age-related sleep change: gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women . J Psychosom Res . 2004. ; 56 ( 5 ): 503 – 510 .
    1. Bixler EO , Papaliaga MN , Vgontzas AN , et al. . Women sleep objectively better than men and the sleep of young women is more resilient to external stressors: effects of age and menopause . J Sleep Res . 2009. ; 18 ( 2 ): 221 – 228 .
    1. Goel N , Kim H , Lao RP . Gender differences in polysomnographic sleep in young healthy sleepers . Chronobiol Int . 2005. ; 22 ( 5 ): 905 – 915 .
    1. Mong JA , Cusmano DM . Sex differences in sleep: impact of biological sex and sex steroids . Philos Trans R Soc Lond B Biol Sci . 2016. ; 371 ( 1688 ): 20150110 .
    1. Cusmano DM , Hadjimarkou MM , Mong JA . Gonadal steroid modulation of sleep and wakefulness in male and female rats is sexually differentiated and neonatally organized by steroid exposure . Endocrinology . 2014. ; 155 ( 1 ): 204 – 214 .
    1. Yamaoka S . Modification of circadian sleep rhythms by gonadal steroids and the neural mechanisms involved . Brain Res . 1980. ; 185 ( 2 ): 385 – 398 .
    1. Byun J-H , Kim KT , Moon HJ , Motamedi GK , Cho YW . The first night effect during polysomnography, and patients’ estimates of sleep quality . Psychiatry Res . 2019. ; 274 : 27 – 29 .
    1. Eckert DJ , Malhotra A . Pathophysiology of adult obstructive sleep apnea . Proc Am Thorac Soc . 2008. ; 5 ( 2 ): 144 – 153 .
    1. Kwon Y , Logan J , Pusalavidyasagar S , Kasai T , Cheong CSJ , Lee C-H . Sleep apnea and heart . Sleep Med Res . 2019. ; 10 ( 2 ): 67 – 74 .
    1. Knutson KL . Does inadequate sleep play a role in vulnerability to obesity? Am J Hum Biol . 2012. ; 24 ( 3 ): 361 – 371 .
    1. Wichniak A , Wierzbicka A , Walęcka M , Jernajczyk W . Effects of antidepressants on sleep . Curr Psychiatry Rep . 2017. ; 19 ( 9 ): 63 .

Source: PubMed

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