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Original Research: Sleep Disorders |

Inverse Relationship of Subjective Daytime Sleepiness to Sympathetic Activity in Patients With Heart Failure and Obstructive Sleep ApneaSleepiness and Sympathetic Activity

Luigi Taranto Montemurro, MD; John S. Floras, MD, DPhil; Philip J. Millar, PhD; Takatoshi Kasai, MD, PhD; Joseph M. Gabriel, MSc; Jonas Spaak, MD, PhD; Fernando Morgadinho S. Coelho, MD, PhD; T. Douglas Bradley, MD
Author and Funding Information

From the Sleep Research Laboratory of the Toronto Rehabilitation Institute (Drs Taranto Montemurro, Kasai, and Bradley and Mr Gabriel); the Department of Medicine of the University Health Network and Mount Sinai Hospital (Drs Floras, Millar, Spaak, and Bradley); the Department of Medicine (Dr Coelho), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; and the Department of Clinical Sciences (Dr Spaak), Danderyd University Hospital, Karolinska Institutet, Danderyd, Sweden.

Correspondence to: Luigi Taranto Montemurro, MD, A.O. Mellino Mellini, Centro per la ricerca e terapia dei disturbi cardio-respiratori nel sonno, Viale Mazzini 4, 25032 Chiari (BS), Italy; e-mail: taranto.luigi@gmail.com


Funding/Support: This study was supported by the Canadian Institute of Health Research [operating grant MOP-82731], and by the Heart and Stroke Foundation of Canada, the Canada Foundation for Innovation, the Ontario Innovation Trust, and the Ministry of Research and Innovation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1222-1228. doi:10.1378/chest.11-2963
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Background:  Patients with heart failure (HF) and obstructive sleep apnea (OSA) are less sleepy than patients with OSA but without HF. Furthermore, unlike the non-HF population, in the HF population, the degree of daytime sleepiness is not related to the apnea-hypopnea index (AHI). The sympathetic nervous system plays a critical role in alertness. HF and OSA both increase sympathetic nervous system activity (SNA) during wakefulness. We hypothesized that in patients with HF and OSA, the degree of subjective daytime sleepiness would be inversely related to SNA.

Methods:  Daytime muscle SNA (MSNA) was recorded in patients with HF and OSA. Subjective daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS).

Results:  We studied 27 patients with HF and OSA and divided them into two groups based on the median ESS score: a less sleepy group, with an ESS score < 6 (n = 13), and a sleepier group, with an ESS score ≥ 6 (n = 14). The less sleepy group had higher MSNA than did the sleepier group (82.5 ± 9.9 bursts/100 cardiac cycles vs 69.3 ± 18.6 bursts/100 cardiac cycles; P = .037) and a longer sleep-onset latency (33 ± 29 min vs 14 ± 13 min; P = .039). The ESS score was inversely related to MSNA (r = −0.63; P < .001) but not to the AHI, arousal index, or indices of oxygen desaturation.

Conclusions:  In patients with HF and OSA, the degree of subjective daytime sleepiness is inversely related to MSNA. This relationship is likely mediated via central adrenergic alerting mechanisms. These findings help to explain the previously reported lack of daytime hypersomnolence in patients with HF and OSA.

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