Factors influencing excessive daytime sleepiness in obstructive sleep apnea: A retrospective cohort analysis integrating psychological assessment with polysomnography.

OBJECTIVE

This study aimed to systematically evaluate psychological and polysomnographic parameters to analyze factors influencing excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA).

METHODS

We conducted a retrospective study of 318 adult OSA patients from a tertiary hospital sleep center. Participants underwent overnight polysomnography and completed questionnaires including the Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Mood Disorder Questionnaire (MDQ). Statistical analyses involved univariate and multivariable logistic regression, with dose-response relationships assessed using restricted cubic splines.

RESULTS

Among 318 OSA patients, 95 (29.9 %) had EDS (ESS >10). The EDS group showed significantly higher PHQ-9, GAD-7, and MDQ scores (all p < 0.05). Polysomnography revealed that EDS patients exhibited longer total sleep time, shorter wake after sleep onset, higher apnea-hypopnea index (AHI), elevated AHI during rapid eye movement sleep, and reduced lowest oxygen saturation. After adjusting for confounders, multivariable analysis identified PHQ-9 scores (OR = 1.12, 95 %CI:1.06-1.18), MDQ scores (OR = 1.16, 95 %CI:1.06-1.27), and respiratory arousal index (OR = 1.03, 95 %CI:1.01-1.05) as independent risk factors for EDS, all demonstrating significant positive linear dose-response relationships.

CONCLUSION

Our findings indicate that depressive symptoms, subclinical affective instability, and respiratory arousals are independently associated with EDS in OSA patients, with clear dose-response relationships. These results suggest that a multifactorial framework encompassing both psychological and physiological domains may be a valuable direction for understanding EDS, and warrant future investigation into the clinical value of integrated assessments.