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Kim, Lee, Kang, Kang, Kim, Kim, Kim, Song, Park, and Moon: Relationship between Arousal Indices and Clinical Manifestations in Patients Who Performed Polysomnography
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(3): 183-190.

Published online: 30 September 2009

DOI: https://doi.org/10.4046/trd.2009.67.3.183

Relationship between Arousal Indices and Clinical Manifestations in Patients Who Performed Polysomnography

Sung Kyoung Kim, M.D., Sang Haak Lee, M.D., Hyeon Hui Kang, M.D., Ji Young Kang, M.D., Jin Woo Kim, M.D., Young Kyoon Kim, M.D., Kwan Hyoung Kim, M.D., Jeong Sup Song, M.D., Sung Hak Park, M.D., Hwa Sik Moon, M.D.

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Address for correspondence: Hwa Sik Moon, M.D. Division of Pulmonology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, 620-56, Jeonnong 2-dong, Dongdaemoon-gu, Seoul 130-709, Korea. Phone: 82-2-958-2463, Fax: 82-2-968-7250, hsmoon@catholic.ac.kr

Received 1 July 2009       Accepted 13 August 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Repeated arousals during sleep have been known to be associated with excessive daytime sleepiness and cardiovascular complications. We investigated the relationship between arousal indices and clinical parameters.

Methods

We retrospectively reviewed medical records of 41 patients who performed polysomnography for a diagnosis of obstructive sleep apnea syndrome. We defined total arousal index (TAI) as the number of arousals per hour and respiratory arousal index (RAI) as the number of arousals associated with apnea or hypopnea per hour.

Results

There were significant positive correlations between arousal indices and apnea-hypopnea index (AHI) (RAI vs. AHI, r=0.958, p<0.001; TAI vs. AHI, r=0.840, p<0.001). RAI and mean oxygen saturation showed a significant negative correlation with each other (r=-0.460, p=0.002). TAI revealed a significant positive correlation with mean systolic blood pressure (MSBP) and mean diastolic blood pressure (MDBP) (TAI vs. MSBP, r=0.389, p=0.014; TAI vs. MDBP, r=0.373, p=0.019). There was no significant correlation between arousal indices and parameters of sleepiness. RAI had a significant positive correlation with body mass index (BMI) and neck circumference (NC) (RAI vs. BMI, r=0.371, p=0.017; RAI vs. NC, r=0.444, p=0.004). When partial correlation analysis was performed to adjust for other variables, there was significant correlation between RAI and AHI (r=0.935, p<0.001).

Conclusion

This study shows that respiratory arousal index could be a useful index reflecting of severity of obstructive sleep apnea syndrome. Arousal during sleep would be concerned in the development of cardiovascular complication of obstructive sleep apnea. And some anthropometric factors would contribute to the development of arousals during sleep. Further studies are needed to clarify any cause-effect relationship.

Keywords: Arousal, Polysomnography, Obstructive sleep apnea

Figures and Tables

Figure 1
Relationship between arousal index and apnea hypopnea index (AHI).
trd-67-183-g001
Figure 2
Relationship between arousal index and mean O2 saturation and lowest O2 saturation.
trd-67-183-g002
Figure 3
Relationship between arousal index and blood pressure. MSBP: mean systolic blood pressure; MDBP: mean diastolic blood pressure.
trd-67-183-g003
Figure 4
Relationship between arousal index and sleepiness scales (All are p>0.05).
trd-67-183-g004
Figure 5
Relationship between arousal index and body mass index and neck circumference.
trd-67-183-g005
Table 1
Clinical and baseline characteristics of study subjects
trd-67-183-i001

Values are mean±standard deviation (range).

BMI: body mass index; AHI: apnea-hypopnea index.

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