Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea

Purbanka Pahari; Henri Korkalainen; Tuomas Karhu; Erna Sif Arnardóttir; Juha Töyräs; Timo Leppänen; Sami Nikkonen

doi:10.1111/jsr.13988

Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea

Purbanka Pahari
, Henri Korkalainen
, Tuomas Karhu
, Erna Sif Arnardóttir
, Juha Töyräs
, Timo Leppänen
, Sami Nikkonen

Department of Engineering

Reykjavik University

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

Abstract

Oxygen saturation (SpO₂)-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO₂-based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO₂-based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1–Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75–11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.

Original language	English
Journal	Journal of Sleep Research
DOIs	https://doi.org/10.1111/jsr.13988
Publication status	E-pub ahead of print - 13 Jul 2023

Bibliographical note

Funding Information: This work was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), the Academy of Finland (project 323536), NordForsk (NordSleep project 90458) via Business Finland (5133/31/2018) and the Icelandic Research Fund, the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041794, 5041805, 5041787, and 5041803), the Research Foundation of the Pulmonary Diseases, Finnish Anti‐Tuberculosis Association, Tampere Tuberculosis Foundation, Instrumentarium Science Foundation, Orion Research Foundation, Respiratory Foundation of Kuopio Region, and Respiratory Diseases Research Foundation. Funding Information: Purbanka Pahari, Henri Korkalainen, Tuomas Karhu, Timo Leppänen, and Sami Nikkonen disclose State Research Funding from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041803, 5041805, 5041787, 5041794, 5041767, 5041768, and 5041809). Purbanka Pahari, Erna Sif Arnardottir, Juha Töyräs, and Timo Leppänen disclose research funding from NordForsk (NordSleep project 90458). Purbanka Pahari also discloses personal grants from the Respiratory Diseases Research Foundation, the Respiratory Foundation of Kuopio Region, and the Orion Research Foundation. Henri Korkalainen discloses funding from the Finnish Anti‐Tuberculosis Association, the Finnish Cultural Foundation, and the Scientific Foundation of Respiratory Diseases. Henri Korkalainen also discloses working contrasts at the Diagnostic Imaging Centre, Kuopio University Hospital; Cancer Centre, Kuopio University Hospital; and the Department of Technical Physics, University of Eastern Finland. Additionally, Henri Korkalainen discloses his leading work package in Sleep Revolution, European Union's Horizon 2020 Research and Innovation Programme under grant agreement number 965417. Tuomas Karhu discloses personal grants from Tampere Tuberculosis Foundation, and Instrumentarium Science Foundation. Erna Sif Arnardottir discloses lecture fees from Nox Medical, Philips, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Alcoa Fjardaral, and Wink Sleep. Erna Sif Arnardottir is also a member of the Philips Sleep Medicine and Innovation Medical Advisory Board. Juha Töyräs and Timo Leppänen disclose project funding from National Health and Medical Research Council (NHMRC), Australia, and European Commission, H2020‐SC1‐2020. Timo Leppänen additionally discloses project funding from the Academy of Finland (project 323536). Publisher Copyright: © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

Other keywords

fall severity
hypoxic load
impaired vigilance
intermittent hypoxemia
recovery severity
sex difference

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@article{4610d86953934eb1924c4b6954f8132f,

title = "Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea",

abstract = "Oxygen saturation (SpO2)-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2-based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2-based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1{\textendash}Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75{\textendash}11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.",

keywords = "fall severity, hypoxic load, impaired vigilance, intermittent hypoxemia, recovery severity, sex difference",

author = "Purbanka Pahari and Henri Korkalainen and Tuomas Karhu and Arnard{\'o}ttir, \{Erna Sif\} and Juha T{\"o}yr{\"a}s and Timo Lepp{\"a}nen and Sami Nikkonen",

note = "Funding Information: This work was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), the Academy of Finland (project 323536), NordForsk (NordSleep project 90458) via Business Finland (5133/31/2018) and the Icelandic Research Fund, the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041794, 5041805, 5041787, and 5041803), the Research Foundation of the Pulmonary Diseases, Finnish Anti‐Tuberculosis Association, Tampere Tuberculosis Foundation, Instrumentarium Science Foundation, Orion Research Foundation, Respiratory Foundation of Kuopio Region, and Respiratory Diseases Research Foundation. Funding Information: Purbanka Pahari, Henri Korkalainen, Tuomas Karhu, Timo Lepp{\"a}nen, and Sami Nikkonen disclose State Research Funding from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041803, 5041805, 5041787, 5041794, 5041767, 5041768, and 5041809). Purbanka Pahari, Erna Sif Arnardottir, Juha T{\"o}yr{\"a}s, and Timo Lepp{\"a}nen disclose research funding from NordForsk (NordSleep project 90458). Purbanka Pahari also discloses personal grants from the Respiratory Diseases Research Foundation, the Respiratory Foundation of Kuopio Region, and the Orion Research Foundation. Henri Korkalainen discloses funding from the Finnish Anti‐Tuberculosis Association, the Finnish Cultural Foundation, and the Scientific Foundation of Respiratory Diseases. Henri Korkalainen also discloses working contrasts at the Diagnostic Imaging Centre, Kuopio University Hospital; Cancer Centre, Kuopio University Hospital; and the Department of Technical Physics, University of Eastern Finland. Additionally, Henri Korkalainen discloses his leading work package in Sleep Revolution, European Union's Horizon 2020 Research and Innovation Programme under grant agreement number 965417. Tuomas Karhu discloses personal grants from Tampere Tuberculosis Foundation, and Instrumentarium Science Foundation. Erna Sif Arnardottir discloses lecture fees from Nox Medical, Philips, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Alcoa Fjardaral, and Wink Sleep. Erna Sif Arnardottir is also a member of the Philips Sleep Medicine and Innovation Medical Advisory Board. Juha T{\"o}yr{\"a}s and Timo Lepp{\"a}nen disclose project funding from National Health and Medical Research Council (NHMRC), Australia, and European Commission, H2020‐SC1‐2020. Timo Lepp{\"a}nen additionally discloses project funding from the Academy of Finland (project 323536). Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of Sleep Research published by John Wiley \& Sons Ltd on behalf of European Sleep Research Society.",

year = "2023",

month = jul,

day = "13",

doi = "10.1111/jsr.13988",

language = "English",

journal = "Journal of Sleep Research",

issn = "0962-1105",

publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea

AU - Pahari, Purbanka

AU - Korkalainen, Henri

AU - Karhu, Tuomas

AU - Arnardóttir, Erna Sif

AU - Töyräs, Juha

AU - Leppänen, Timo

AU - Nikkonen, Sami

N1 - Funding Information: This work was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), the Academy of Finland (project 323536), NordForsk (NordSleep project 90458) via Business Finland (5133/31/2018) and the Icelandic Research Fund, the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767, 5041794, 5041805, 5041787, and 5041803), the Research Foundation of the Pulmonary Diseases, Finnish Anti‐Tuberculosis Association, Tampere Tuberculosis Foundation, Instrumentarium Science Foundation, Orion Research Foundation, Respiratory Foundation of Kuopio Region, and Respiratory Diseases Research Foundation. Funding Information: Purbanka Pahari, Henri Korkalainen, Tuomas Karhu, Timo Leppänen, and Sami Nikkonen disclose State Research Funding from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041803, 5041805, 5041787, 5041794, 5041767, 5041768, and 5041809). Purbanka Pahari, Erna Sif Arnardottir, Juha Töyräs, and Timo Leppänen disclose research funding from NordForsk (NordSleep project 90458). Purbanka Pahari also discloses personal grants from the Respiratory Diseases Research Foundation, the Respiratory Foundation of Kuopio Region, and the Orion Research Foundation. Henri Korkalainen discloses funding from the Finnish Anti‐Tuberculosis Association, the Finnish Cultural Foundation, and the Scientific Foundation of Respiratory Diseases. Henri Korkalainen also discloses working contrasts at the Diagnostic Imaging Centre, Kuopio University Hospital; Cancer Centre, Kuopio University Hospital; and the Department of Technical Physics, University of Eastern Finland. Additionally, Henri Korkalainen discloses his leading work package in Sleep Revolution, European Union's Horizon 2020 Research and Innovation Programme under grant agreement number 965417. Tuomas Karhu discloses personal grants from Tampere Tuberculosis Foundation, and Instrumentarium Science Foundation. Erna Sif Arnardottir discloses lecture fees from Nox Medical, Philips, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Alcoa Fjardaral, and Wink Sleep. Erna Sif Arnardottir is also a member of the Philips Sleep Medicine and Innovation Medical Advisory Board. Juha Töyräs and Timo Leppänen disclose project funding from National Health and Medical Research Council (NHMRC), Australia, and European Commission, H2020‐SC1‐2020. Timo Leppänen additionally discloses project funding from the Academy of Finland (project 323536). Publisher Copyright: © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

PY - 2023/7/13

Y1 - 2023/7/13

N2 - Oxygen saturation (SpO2)-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2-based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2-based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1–Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75–11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.

AB - Oxygen saturation (SpO2)-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2-based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2-based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1–Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (β = 8.05, p < 0.01), FallSev (β = 6.48, p = 0.02), RecovSev (β = 9.13, p < 0.01), and Oxygen Desaturation Index (β = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (β = 10.75–11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.

KW - fall severity

KW - hypoxic load

KW - impaired vigilance

KW - intermittent hypoxemia

KW - recovery severity

KW - sex difference

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UR - https://iris.ru.is/ws/files/211389072/Journal_of_Sleep_Research_-_2023_-_Pahari_-_Reaction_time_in_psychomotor_vigilance_task_is_related_to_hypoxic_load_in_males.pdf

U2 - 10.1111/jsr.13988

DO - 10.1111/jsr.13988

M3 - Article

SN - 0962-1105

JO - Journal of Sleep Research

JF - Journal of Sleep Research

ER -

Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea

Abstract

Bibliographical note

Other keywords

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