Sleep deprivation versus sleep apnea

What are the key features of sleep deprivation versus sleep apnea?

• In sleep deprivation, the person does not sleep but breathes normally. In sleep apnea, the person sleeps but does not breathe well during sleep. One can objectively measure excessive daytime sleepiness (EDS) with a standardized tool, such as the Epworth Sleepiness Scale (ESS).
• One must appreciate that this screening tool is specific but not sensitive. An ESS score > 9 to 10 is consistent with EDS, but not necessarily OSA.
• The greatest clinical use for this scale is serial tracking of patients in response to therapy.
• It is important to remember that the ESS does not correlate with (1) objective testing for sleepiness; (2) likelihood of OSA on overnight PSG; and (3) the patient’s perception of sleep-related problems.
• Patients with acute or chronic shortening of sleep resist the drive to sleep with no impairment of gas exchange. In OSA, there is a repetitive collapse of the upper airway, which induces apneic and hypopneic episodes despite persistent thoracic and abdominal respiratory effort.
• This leads to mechanical loading on the upper airway, chest wall, and diaphragm. What follows are hypoxia, hypercarbia, and a marked increase in SNS tone. OSA often leads to disruption or fragmentation of the usual sleep–wake cycle and endocrine responsiveness.
• Both can contribute to fatigue and daytime sleepiness. In contrast, if EDS is secondary to sleep deprivation, the patient’s sleep continuity is normal and is often associated with an increase in SWS.

Does sleep deprivation worsen mild obstructive sleep apnea?

Here is an abstract of a study conducted with the objective of effect of acute sleep deprivation on polysomnography

Study objectives: Sleep deprivation is believed to worsen obstructive sleep apnea (OSA). A study assessed the effect of acute sleep deprivation on polysomnography in a cohort of subjects with mild OSA and a cohort of subjects without OSA.

Design: Crossover study in which subjects initially had polysomnography after a normal night’s sleep or after 36 hours of sleep deprivation, followed by a 2- to 4-week interval, after which subjects were restudied under the alternate testing condition.

Setting and participants: 13 subjects with mild OSA and 16 subjects without OSA were studied in a university teaching hospital sleep laboratory.

Interventions: 36 hours of supervised sleep deprivation.

Measurements: Subjects’ age, body mass index, neck circumference and Epworth Sleepiness Scale scores were measured; actigraphy and sleep diaries were used to estimate prior sleep debt before each sleep study.

Results: Sleep deprivation was found to significantly increase total sleep time, sleep efficiency, and rapid eye movement and slow-wave sleep time. Subjects with OSA showed a lower minimum oxygen saturation after sleep deprivation. However, subjects did not show a significantly different respiratory disturbance index, arousal index, or length of the longest apnea after sleep deprivation.

Conclusions: Acute sleep deprivation did not worsen most OSA parameters as measured by polysomnography. A lower minimum oxygen saturation in mild OSA subjects after sleep deprivation may be important in patients with significant cardiorespiratory disease. More research is needed to assess whether daytime performance and function (eg, driving, sleepiness) is more greatly impaired in OSA subjects who are sleep deprived, compared to normal subjects who are sleep deprived.

Sources

1.Desai AV, Marks G, Grunstein R. Does sleep deprivation worsen mild obstructive sleep apnea? Sleep. 2003 Dec 15;26(8):1038-41. doi: 10.1093/sleep/26.8.1038. PMID: 14746387.https://pubmed.ncbi.nlm.nih.gov/14746387/