Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms

Jasmin Kuhn; Laura Schiphorst; Bernice M. Wulterkens; Jerryll Asin; Nanny Duis; Sebastiaan Overeem; Merel M. van Gilst; Pedro Fonseca

doi:10.3390/clockssleep6040050

Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms

Jasmin Kuhn
, Laura Schiphorst
, Bernice M. Wulterkens
, Jerryll Asin
, Nanny Duis
, Sebastiaan Overeem (Corresponding author)
, Merel M. van Gilst
, Pedro Fonseca

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

43 Downloads (Pure)

Abstract

Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients’ sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective − self-reported TST)/objective TST. MI values differed significantly between the OSA (median = −0.02, IQR = [−0.06, 0.02]) and the OSA-I group (0.05, [−0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = −0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea–hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = −0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment.

Original language	English
Pages (from-to)	777-788
Number of pages	12
Journal	Clocks & Sleep
Volume	6
Issue number	4
DOIs	https://doi.org/10.3390/clockssleep6040050
Publication status	Published - 5 Dec 2024

Funding

This work was performed within the IMPULS framework of the Eindhoven MedTech Innovation Center (e/MTIC, incorporating Eindhoven University of Technology, Philips, and Sleep Medicine Center Kempenhaeghe), including a PPS supplement from the Dutch Ministry of Economic Affairs and Climate Policy, grant: PISANO. At the time of writing, J.K., L.R.B.S., B.M.W., and P.F. were employed and/or affiliated with Royal Philips, a commercial company and manufacturer of consumer and medical electronic devices, commercializing products in the area of sleep diagnostics and sleep therapy. Philips had no role in the study design, decision to publish, or preparation of the manuscript. J.A. received financial support from Philips and SomnoMed for research and participated in advisory boards for Jazz Pharmaceuticals, Zoll Respicardia, and Bioprojet, all unrelated to the present work. S.O. participated in advisory boards for Jazz Pharmaceuticals, Takeda, Bioprojet, and Abbvie, all unrelated to the present work. The other authors report no conflicts of interest.

Keywords

obstructive sleep apnea
sleep disordered breathing
insomnia
sleep perception
sleep wake cognition
photoplethysmography
Repeated measurements
sleep-wake cognition
repeated measurements

Access to Document

10.3390/clockssleep6040050

pdfFinal published version, 1 MBLicence: CC BY

Cite this

@article{f2b3992a106c481eb81f6e98be48510b,

title = "Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms",

abstract = "Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients{\textquoteright} sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective − self-reported TST)/objective TST. MI values differed significantly between the OSA (median = −0.02, IQR = [−0.06, 0.02]) and the OSA-I group (0.05, [−0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = −0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea–hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = −0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment.",

keywords = "obstructive sleep apnea, sleep disordered breathing, insomnia, sleep perception, sleep wake cognition, photoplethysmography, Repeated measurements, sleep-wake cognition, repeated measurements",

author = "Jasmin Kuhn and Laura Schiphorst and Wulterkens, \{Bernice M.\} and Jerryll Asin and Nanny Duis and Sebastiaan Overeem and \{van Gilst\}, \{Merel M.\} and Pedro Fonseca",

year = "2024",

month = dec,

day = "5",

doi = "10.3390/clockssleep6040050",

language = "English",

volume = "6",

pages = "777--788",

journal = "Clocks \& Sleep",

issn = "2624-5175",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "4",

}

TY - JOUR

T1 - Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms

AU - Kuhn, Jasmin

AU - Schiphorst, Laura

AU - Wulterkens, Bernice M.

AU - Asin, Jerryll

AU - Duis, Nanny

AU - Overeem, Sebastiaan

AU - van Gilst, Merel M.

AU - Fonseca, Pedro

PY - 2024/12/5

Y1 - 2024/12/5

N2 - Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients’ sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective − self-reported TST)/objective TST. MI values differed significantly between the OSA (median = −0.02, IQR = [−0.06, 0.02]) and the OSA-I group (0.05, [−0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = −0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea–hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = −0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment.

AB - Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients’ sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective − self-reported TST)/objective TST. MI values differed significantly between the OSA (median = −0.02, IQR = [−0.06, 0.02]) and the OSA-I group (0.05, [−0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = −0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea–hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = −0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment.

KW - obstructive sleep apnea

KW - sleep disordered breathing

KW - insomnia

KW - sleep perception

KW - sleep wake cognition

KW - photoplethysmography

KW - Repeated measurements

KW - sleep-wake cognition

KW - repeated measurements

UR - https://www.scopus.com/pages/publications/85213539340

U2 - 10.3390/clockssleep6040050

DO - 10.3390/clockssleep6040050

M3 - Article

C2 - 39727626

SN - 2624-5175

VL - 6

SP - 777

EP - 788

JO - Clocks & Sleep

JF - Clocks & Sleep

IS - 4

ER -

Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms

Abstract

Funding

Keywords

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Sleep Medicine

Cite this

Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Research areas

Sleep Medicine

Cite this