Objective: To measure the readjustments of sleep macro- and microstructure
in patients with obstructive sleep apnea syndrome (OSAS) after acute nasal
continuous positive airway pressure (NCPAP) treatment. Background: The conv
entional polysomnographic analysis (macrostructure of sleep) does not neces
sarily provide the best measures of sleep disruption associated with OSAS.
In contrast, microstructural methods of analyzing sleep (i.e., arousals and
cyclic alternating pattern) may improve evaluation of patients with OSAS.
Method: Ten patients with OSAS were monitored polygraphically before and du
ring the first night of NCPAP therapy. The results were compared with those
of 10 age- and sex-matched controls without sleep-related breathing disord
ers. Each nocturnal recording was followed by daytime observation using the
multiple sleep latency test and Visual Analogue Scale (VAS). Results: The
first night of ventilatory therapy was characterized by a remarkable expans
ion of stages 3 and 4 and of REM sleep. In addition, NCPAP suppressed the p
resence of cyclic alternating pattern (CAP) in REM sleep and induced an imp
ressive rebound of arousals and of certain CAP variables-i.e., CAP rate, CA
P time, number of CAP cycles-which dropped well below the physiologic value
s expressed by controls. A normal duration of phases A and B was re-establi
shed starting the first treatment night. When we matched sleep variables wi
th the indices of daytime function, a significant correlation emerged only
between the variations of CAP rate and VAS scores. In particular, improveme
nt of daytime sleepiness was less evident when the ventilatory-induced drop
of CAP rate was more pronounced. Conclusions: The application of CAP varia
bles to the microstructural analysis of sleep may expand our knowledge rega
rding sleep and respiration.