Cycling alternating and Alpha-EEG patterns may contribute to CPAP non-compliance among Sleep Apnea patients

摘要

CPAP compliance is a therapeutic challenge. Although there may be PSG evidence of control of OSA with a reduction in AHI, snoring, nocturnal awakenings, improved oxygen saturation, and reduced daytime sleepiness, some patients continue to report residual non-restorative sleep with marked daytime fatigue which might be associated with PSG evidence of cycling alternating pattern (CAP) and alpha electroencephalography pattern (alpha-EEG). CAP and alpha-EEG are markers of sleep instability and are associated with autonomic instability, non-restorative sleep, daytime fatigue, variable musculoskeletal pain, and cognitive issues with memory and concentration. These markers of sleep instability do not generally respond longer-term to hypnotic medication and are a potential barrier to CPAP compliance. Patients with combined OSA and markers of sleep instability suffer from both sleepiness and fatigue and are more likely to erroneously deduce that CPAP treatment has not been of benefit and abandon treatment. In this pilot study we identified 6 OSA patients with CAP and/or alpha-EEG, who were non-compliant with CPAP and who had abnormally high scores on an Adrenal Fatigue Questionnaire and have clinical evidence of low saliva cortisol throughout the day. On the Symptom Checklist-90 (SCL-90) patients reported moderate to excessive psychological distress with anxiety and depressive symptoms, on the Wahler Physical Symptoms Inventory there was evidence of marked physical fatigue and discomfort and elevated scores on the Epworth Sleepiness Scale. In addition to CPAP, these patients were treated with a multimodal approach addressing the physical, biochemical, bio-electrical and psychological factors. Subjective improvement in their sleep, improvement in their daytime sleepiness and fatigue, decrease in CAP and/or alpha-EEG, as well as higher rates of CPAP compliance were observed with this therapeutic approach.