Influence of alcohol on respiratory disturbance during sleep

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<ul><li><p>Psychiatry and Clinical Neurosciences (2000), 54, 332333</p><p>Sleep Breathing Disorders</p><p>Influence of alcohol on respiratory disturbance during sleep</p><p>WAKAKO TSUTSUMI, md,1 SOICHIRO MIYAZAKI, md, phd,2</p><p>YOSHIAKI ITASAKA, phd2 AND KIYOSHI TOGAWA, md, phd11Department of Otorhinolaryngology,Akita Red Cross Hospital and 2Department of Otorhinolaryngology,Akita University School of Medicine,Akita, Japan </p><p>Abstract Oxygen saturation was measured in 37 patients with sleep-related breathing disorders over 2nights: after alcohol intake and under control conditions. Both the number of 3% oxygen desatu-ration per hour (ODI3) and the lowest saturation (LSAT) were significantly aggravated afteralcohol ingestion. Oxygen saturation was degraded in 28 cases after alcohol intake. In 69% of thecases in which ODI3 increased after alcohol ingestion, the aggravation during the alcohol me-tabolism time was noted. No correlation was found between the quantity of alcohol and oxygendesaturation following alcohol ingestion. Our study revealed that alcohol aggravates sleep-related breathing disorders.</p><p>Key words alcohol, oxygen saturation, respiratory disturbance, sleep.</p><p>INTRODUCTION</p><p>It is well known that alcohol may cause snoring innormal subjects or aggravate already existing sleepapnea. In this study, we examined the influence of alcohol in subjects with sleep-related breathing disorders.</p><p>SUBJECTS AND METHODS</p><p>Thirty-seven patients (all male; average age =46.9 years; average body mass index = 26.4 kg/m2) with sleep-related breathing disorders were examinedby means of pulse oximetry. The arterial blood oxygensaturation (SaO2) during sleep was recorded follow-ing alcohol intake and under control conditions.The quantity of ethanol at examination was randomlydetermined in each individual. We calculated thenumber of 3% oxygen desaturation per hour (ODI3).A significant aggravation of ODI3 was determined as a 10% increase following alcohol ingestion or anincrease of ODI3 over 5 h in the cases whose ODI3was under 5 h on the control night. Lowest saturation(LSAT) was defined as the value of the lowest oxygensaturation during a night, and a significant aggrava-</p><p>tion of LSAT was defined as a 5% decrease afteralcohol intake. We adopted the data that the meta-bolic elimination volume of ethanol was 10 mL perhour.1</p><p>RESULTS</p><p>One case, a 57-year-old male, was examined following144 mL ethanol ingestion and under control condi-tions. The ODI3 increased remarkably after alcoholingestion (15.3/h) as compared with under controlconditions (2.0/h). The LSAT decreased from 88%without alcohol to 80% after alcohol intake. Thedegradation of SaO2 was remarkable in the earlystages of sleep. In all 37 cases, LSAT decreased signifi-cantly (P &lt; 0.0001) following alcohol ingestion (81.1%after alcohol intake, 85.6% on the control night). Thenumber of ODI3 significantly (P = 0.0104) increasedafter alcohol intake (15.9/h), as compared with thecontrol value (12.7/h). All cases were classified intothree groups according to the change of ODI3 andLSAT as (Table 1):</p><p>1. Group 1, 12 cases (32%): both ODI3 and LSATwere aggravated.</p><p>2. Group 2, 28 cases (76%): ODI3 or LSAT wasaggravated.</p><p>3. Group 3, 9 cases (24%): no aggravation of ODI3and LSAT.</p><p>Correspondence address: Wakako Tsutsumi, Department of Otorhi-nolaryngology, Niigata University School of Medicine, 1-754 Asahi-machi-dori, Niigata 951-8510, Japan. Email:</p></li><li><p>Influence of alcohol on respiratory disturbance during sleep 333</p><p>No significant difference was observed in relationto age, body mass index, or degree of respiratory dis-turbance during sleep between the non-aggravationgroup and the aggravation group. Although the quan-tity of ethanol at the examination was indistinct in sixof nine non-aggravated cases, the usual quantity ofethanol in the non-aggravated group (45.9 mL) wassignificantly small compared with that in the aggra-vated group (82.5 mL). The ODI3 increased in 16 of27 cases in which the quantity of ethanol at the ex-amination was recorded, and in 11 (69%) of these 16cases ODI3 increased more significantly than theother five cases within the ethanol elimination time.</p><p>DISCUSSION</p><p>It has been reported that alcohol has influence notonly on sleep but also on respiration.2 Alcohol shortens sleep initiation time, and a large quantity of alcohol increases the occurrence of the third andfourth phases of non-REM sleep.3 Our results showeda significant degradation of SaO2 after alcohol intakeand aggravation in 69% of 16 ODI3 increased caseswithin the ethanol metabolism time. It is interestingthat 24% of all cases indicated no aggravation afteralcohol ingestion. The usual quantity of alcohol in thenon-aggravated group was significantly small com-</p><p>pared with the aggravated group. Another possibleexplanation for non-aggravation may be individualdifferences in metabolizing alcohol and in alcohol tol-erance. In this study, the relationship between thequantity of alcohol and oxygen desaturation afteralcohol intake was uncertain.</p><p>CONCLUSION</p><p>In 28 (76%) of 37 cases with sleep-related breathingdisorders, oxygen saturation was significantly aggra-vated after alcohol ingestion. Although no significantrelationship was found between the quantity ofalcohol and oxygen desaturation after alcohol inges-tion, our data revealed that alcohol worsens the sleep-related breathing disorders in certain individuals.</p><p>REFERENCES</p><p>1. Ishii H. Alcohol MedicineClinic of Organic and Meta-bolic Disorders. Igaku-syoin, Tokyo, 1981 (in Japanese).</p><p>2. Guilleminault C, Silvestri R. Aging and sleep apnea:action of benzodiazepine, acetazolamide, alcohol, andsleep deprivation in a healthy elderly group. J. Gerontol.1984; 39: 655661.</p><p>3. Yules RB, Lippman ME, Freedman DX. Alcohol admin-istration prior to sleep. The effect on EEG sleep stages.Arch. Gen. Psychiatry 1967; 16: 94110.</p><p>Table 1. Comparison of aggravated group and non-aggravated group</p><p>Aggravation (ODI3 and LSAT) Aggravation (ODI3 or LSAT) Non-aggravation</p><p>No. cases 12 (32%) 28 (76%) 9 (24%)Age (years) 46.1 46.4 48.2BMI (kg/m2) 27.3 26.8 25.4Quantity of ethanol at examination (mL) 88.4 (9 cases) 64.4 (24 cases) 98.0 (3 cases)Usual quantity of ethanol (mL) 82.5 (10 cases) 71.8 (22 cases) 45.9 (8 cases)ODI3 (/h) 11.9 13.9 8.7ODI3 (/h) (after alcohol intake) 20.2 18.5 7.7LSAT (%) 86.1 85.1 87.4LSAT (%) (after alcohol intake) 77.6 79.3 86.6</p><p>ODI3, the number of 3% oxygen desaturation per hour; LSAT, the lowest saturation; BMI, body mass index.</p></li></ul>