Correspondence

Snoring and Sleep-Related Breathing Abnormality during Partial Sleep Deprivation

N Engl J Med 1993; 328:1279April 29, 1993

Article

To the Editor:

Snoring may decrease daytime alertness in the absence of repetitive or sustained hypoxia1.

Acute total sleep deprivation can worsen sleep-disordered breathing in patients with obstructive sleep apnea syndrome2. No data are available on the influence of prolonged partial sleep deprivation on snoring and sleep-disordered breathing. Prolonged partial sleep deprivation is a common feature of many occupations, particularly shift-work (around the clock) operations.

We subjected six persons (two normal controls, two subjects with mild obstructive sleep apnea, and two subjects with moderate obstructive sleep apnea) to the same protocol of prolonged partial sleep deprivation over a period of six days. They were permitted four hours of sleep a day. All subjects were continuously monitored by trained personnel to ensure that they did not sleep or nap outside their allotted sleep time. Abnormal respiratory events and total snoring time (frequency-spectrum analysis) were quantified during an adaptation night, a base-line recording, and all six nights of the sleep-deprivation period with the use of a monitor that verified the occurrence of snoring and sleep apnea (Mesam IV). All subjects reported a progressive increase in daytime sleepiness with progression of cumulative sleep deprivation. All four subjects with mild or moderate sleep apnea had significantly more abnormal respiratory events (31 ±12 vs. 20 ±9 episodes of oxygen desaturation of ≥ 3 percent per hour of sleep; P<0.05) and a significantly lower minimal oxygen saturation value (P<0.01) during the period of cumulative sleep deprivation as compared with the base-line night. The two controls did not have an increase in the number of abnormal respiratory events during the period of sleep deprivation. However, all subjects, including the controls, had a significant increase (P<0.009) in the percentage of time spent snoring, according to the sound-frequency analysis performed with the monitor (Figure 1Figure 1Effect of Sleep Deprivation on the Percentage of Time Spent Snoring during Sleep in Subjects with Obstructive Sleep Apnea and Normal Subjects.). At base line, the controls snored only intermittently.

This study indicates that prolonged partial sleep deprivation may have an effect on the number of apneic events during sleep and the severity of decreases in oxygen saturation. Importantly, it may have an effect on daytime alertness and the time spent snoring during sleep in noncomplaining subjects who snore only intermittently under conditions of sleep satiety.

Riccardo A. Stoohs, M.D.
William C. Dement, M.D., Ph.D.
Stanford University Sleep Research Center, Stanford, CA 94305

2 References

1. 1

   Guilleminault C, Stoohs R, Duncan S. Snoring (I): daytime sleepiness in regular heavy snorers. Chest 1991;99:40-48
   CrossRef | Web of Science | Medline

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   Guilleminault C, Rosekind M. The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir 1981;17:341-349
   Medline

Citing Articles (5)

Citing Articles

1. 1

   Patricia Tassi, Sarah Schimchowitsch, Odile Rohmer, Maxime Elbaz, Anne Bonnefond, Patricia Sagaspe, Jacques Taillard, Damien Léger, Pierre Philip. (2011) Effects of acute and chronic sleep deprivation on daytime alertness and cognitive performance of healthy snorers and non-snorers. Sleep Medicine
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2. 2

   Afshin Shirani, Sergio Paradiso, Mark Eric Dyken. (2011) The impact of atypical antipsychotic use on obstructive sleep apnea: A pilot study and literature review. Sleep Medicine 12:6, 591-597
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3. 3

   E. P. Ng, D. K. Ng, C. H. Chan. (2009) Sleep duration, wake/sleep symptoms, and academic performance in Hong Kong Secondary School Children. Sleep and Breathing 13:4, 357-367
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   Antonio Benetó, Enriqueta Gomez-Siurana, Pilar Rubio-Sanchez. (2009) Comorbidity between sleep apnea and insomnia. Sleep Medicine Reviews 13:4, 287-293
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5. 5

   Lyle J Palmer, Susan Redline. (2003) Genomic approaches to understanding obstructive sleep apnea. Respiratory Physiology & Neurobiology 135:2-3, 187-205
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