Subjective sleep quality reflects sleep continuity rather than respiratory severity or sleep stage composition.

Authors

Damla Azakli Yazici, Eslem Gül, Ecem Bilensoy, Ayşe Bahadir, Sibel Yurt, Mehmet Akif Ozgul

Published in

Sleep medicine. Volume 147. Pages 109163. Jul 25, 2026. Epub Jul 25, 2026.

Abstract

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.
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.
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.
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.

PMID:
42526098
Bibliographic data and abstract were imported from PubMed on 30 Jul 2026.

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