Subjective sleep quality reflects sleep continuity rather than respiratory severity or sleep stage composition
Sleep Medicine, cilt.147, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 147
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.sleep.2026.109163
- Dergi Adı: Sleep Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Psycinfo, Academic Search Ultimate (EBSCO)
- Anahtar Kelimeler: WASO, FUSP, Groningen, Sleep quality
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background Positive airway pressure (PAP) therapy normalizes respiratory events in obstructive sleep apnea (OSA), yet many patients report poor sleep quality despite adequate physiological control. This suggests that conventional respiratory indices may fail to capture key determinants of subjective sleep experience. We hypothesized that sleep continuity, rather than respiratory severity or sleep stage composition, is more closely associated with perceived sleep quality. Methods In this cross-sectional study, adults undergoing in-laboratory polysomnography (PSG), including diagnostic and PAP titration nights, completed the Groningen Sleep Quality Scale (GSQS) after awakening. Polysomnographic variables reflecting respiratory metrics, sleep architecture, and continuity were extracted. Logistic regression identified predictors of poor subjective sleep quality (GSQS ≥6). Discrimination was assessed using receiver operating characteristic analysis, and a continuity-based Objective Sleep Quality Index (OSQI) was derived. Results Among 37 participants, 68% reported poor subjective sleep quality. Respiratory indices, including apnea–hypopnea index (AHI), oxygenation measures, and REM- or non-REM–specific event rates, did not differ between good and poor sleepers. In contrast, poor subjective sleep quality was associated with longer wake after sleep onset (WASO), reduced sleep efficiency, and increased N1 sleep. WASO was the strongest predictor. A parsimonious model including WASO, the first uninterrupted sleep period (FUSP), and sex showed the best discrimination (AUC 0.85). The OSQI demonstrated good sensitivity and specificity. Conclusions Subjective sleep quality after laboratory studies appears to be more closely associated with sleep continuity than with respiratory severity or sleep stage composition. A continuity-based index integrating WASO, FUSP, and sex showed promising discriminatory performance but requires validation in larger independent cohorts.