Clinical Study On The Etiology Of Excessive Daytime Sleepiness Based On Sleep Monitoring Techniques

Background Excessive daytime sleepiness(EDS)is a common symptom of sleep disorders.The common diseases that cause EDS include obstructive sleep apnea(OSA),narcolepsy,idiopathic sleepiness,and depressive episodes,etc.EDS may not only reduce the efficiency of study and work,but also cause attention deficit,memory loss and emotional disorders,which seriously affect work and life.Early and effective evaluation of EDS and the etiological diagnosis are particularly important.The multiple sleep latency test(MSLT)is the"gold standard"for objective assessment of sleepiness.There is no MSLT operation guide in China,so it is easy to cause misdiagnosis and missed diagnosis due to non-standard operation.Objective To explore the diagnostic value of sleep monitoring technology for the etiology of EDS.Method 115 patients with EDS were enrolled with overnight polysomnography and MSLT in the next day.According to clinical symptoms,polysomnography(PSG)and MSLT results,the patients were divided into narcolepsy group(34 cases),depression with EDS group(39 cases),obstructive sleep apnea(OSA)group(25 cases)and idiopathic hypersomnia group(11 cases).PSG analysis indicators:total sleep time(TST),sleep efficiency(SE),sleep latency(SL)and rapid eye movement sleep latency(RL),non-rapid eye movement sleep periods(N1,N2 and N3)time and the percentage of total sleep time(N1%,N2%,N3%),REM time and the percentage of total sleep time(REM%),arousal times(AT)and wake time after sleep onset(WASO).MSLT analysis indicators:mean sleep latency(MSL),mean REM sleep latency(MRL),and number of sleep onset REM period(SOREMP).Normally distributed data were expressed as mean±standard deviation,differences between groups were analyzed by one-way ANOVA,and pairwise comparison was performed by SNK-Q test.Non-normally distributed data were described by quartiles[M(Q1,Q3)],differences between groups were described by Kruskal-Wallis H test,and pairwise comparison was performed by t test method.The count data was expressed as rate(%),and the Fisher’s exact probability method was used for comparison.Results(1)The general information:The narcolepsy group and the OSA group were more common in men,and the depression with EDS group and the IH group were more common in women.The age of onset in the depression with EDS group was the youngest(19.1±9.0 years old),followed by the narcolepsy group[18.0(12.0,69.0)years old]and the IH group(31.0±18.5 years old),and the OSA group was the oldest(55.9±17.0 years old)(Z=13.835,P=0.003).Pairwise comparison showed that the age of the OSA group was significantly higher than that of the narcolepsy group and the depression with EDS group(P<0.05).(2)PSG results:All the patients in the four groups had different degrees of sleep structure disorder,mainly manifested as an increase in N1%,a decrease in N3%and REM%.Among them,N1%increase was more obvious in OSA group,and N3%and REM%decrease was more serious.The indicators with differential value among the four groups were SL(Z=10.536,P=0.015),RL(Z=12.217,P=0.007),N3(Z=8.034,P=0.045)and REM%(Z=11.327,P=0.010).Pairwise comparison showed that the RL of the narcolepsy group(median 20.5 mins)was significantly shorter than that of the depression with EDS group(median 132.5 mins,P<0.05).The N3 time of the OSA group(mean 13.0 mins)was significantly lower than that of the depression with EDS group(mean 61.8 mins,P<0.05).There was a significant difference in AHI among the four groups(Z=21.491,P<0.001),and the AHI in the OSA group was the highest[16.3(6.9,60.1)times/h],and the other three groups could not meet the OSA diagnostic criteria.(3)MSLT results:There was a significant difference in MSL among the four groups(F=9.390,P<0.001).Pairwise comparison showed that the MSL(6.7±3.7 mins)of the narcolepsy group was significantly lower than that of the OSA group(15.1±6.0mins),the depression with EDS group(11.0±2.8 mins)and the IH group(13.2±1.1 mins,Ps<0.05).There was a significant difference in the incidence of SOREMP among the four groups(?~2=32.894,P<0.001).Among them,SOREMP was seen in all the narcolepsy group,and most(68%)cases were seen in the other three groups(only18.2%in the IH group).There was also a significant difference in the number of SOREMP among the four groups(Z=23.394,P<0.001).The number of SOREMP in narcolepsy group[3.0(2.0,5.0)]was significantly higher than that in the other three groups(P<0.05).Conclusion Sleep monitoring technology combined with medical history can accurately reflect the etiology of EDS.