Matthew P Butler1,2,3,4, Carolina Smales3, Huijuan Wu3,4,5, Mohammad V Hussain3, Yusef A Mohamed3, Miki Morimoto3, Steven A Shea1,6,3,4. 1. Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR. 2. Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR. 3. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA. 4. Division of Sleep Medicine, Harvard Medical School, Boston, MA. 5. Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China. 6. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.
Abstract
STUDY OBJECTIVE: To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. DESIGN: Within-subject and between-subjects. SETTINGS: Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. PARTICIPANTS: Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. INTERVENTIONS: Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. MEASUREMENTS AND RESULTS: Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. CONCLUSIONS: The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea.
STUDY OBJECTIVE: To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. DESIGN: Within-subject and between-subjects. SETTINGS: Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. PARTICIPANTS: Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. INTERVENTIONS: Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. MEASUREMENTS AND RESULTS: Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. CONCLUSIONS: The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea.
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