Sleep Disorders: Sleep Disorders 1 |

Sleep State Perception: Effects of Age, Gender, and Co-Existing Sleep Disorders FREE TO VIEW

Yitzchak Weinberger, MD; Leon Kaganovskiy; Michael Weinstein, MD
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Winthrop University Hospital, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1266A. doi:10.1016/j.chest.2016.08.1380
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SESSION TITLE: Sleep Disorders 1

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The clinical diagnosis of insomnia rests almost entirely on a patient’s subjective reporting of difficulty initiating or difficulty maintaining sleep. Paradoxical insomnia, or sleep-state misperception, refers to a situation where the patient’s perception of insomnia does not correspond to reality; the patient’s subjective assessment of sleep is less than the objective measurement thereof. Theoretically, many factors could contribute to this misperception, including gender, age and various sleep disorders. In this study we investigated the relationship of self-reported sleep perceptions to objective sleep measures in children and adults undergoing an in-lab polysomnography (PSG).

METHODS: Objective measures of total sleep time (TST) and sleep latency (SL) were compared to subjective patient reports. Age, gender, obstructive sleep apnea (OSA) and periodic limb movement disorder (PLMD) were hypothesized to affect sleep perception. Patients (ages 12 to 85) who underwent polysomnography at our sleep center during a three month period were selected. A questionnaire at the study’s conclusion was answered to subjectively quantify TST and SL. This was compared to objective measures of sleep parameters on PSG. OSA and PLMD were quantified based on the event index (AHI and PLMI, respectively). Differences between subjective and objective TST and SL were computed and their means were compared by gender, age, AHI and PLMI. Group comparisons with ANOVA testing were performed.

RESULTS: A total of 211 patients were studied. The numbers of males and females were approximately equal. The mean age was 48 years. The biggest difference in TST was observed in the 12-20 years age group, but it was not statistically significant (p-value 0.5). No significant difference in TST or SL were observed with OSA (p-value 0.68, 0.92 respectively). A significant difference in TST was observed in females (p-value 0.02) and with the presence of PLMD (p-value 0.0173).

CONCLUSIONS: In conclusion, this study suggests that (i) the presence of PLMD may contribute to sleep state misperception and (ii) females are more susceptible to sleep state misperception. Although the younger age population did seem to have a propensity towards sleep state this was not found to be statistically significant. OSA was also not found to contribute to sleep state misperception. This study has several limitations. First, the study did not account for confounding factors such as underlying medical conditions or medications that patients were taking were not examined. Second, the relatively small sample size may have underpowered the study’s results.

CLINICAL IMPLICATIONS: Paradoxical insomnia is a challenging and elusive diagnosis as it has no objective findings to support its diagnosis. Our study results should guide clinicians treating insomnia to be more wary of paradoxical insomnia when the factors of PLMD or female gender are present.

DISCLOSURE: The following authors have nothing to disclose: Yitzchak Weinberger, Leon Kaganovskiy, Michael Weinstein

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