Punjabi Naresh M, Newman Anne B, Young Terry B, Resnick Helaine E, Sanders Mark H
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
Am J Respir Crit Care Med. 2008 May 15;177(10):1150-5. doi: 10.1164/rccm.200712-1884OC. Epub 2008 Feb 14.
Epidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events.
The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.
A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease.
Using a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (<1.10 events/h), 1.10 (1.01-3.20 events/h), 1.33 (3.21-7.69 events/h), and 1.41 (>7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease.
Hypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopneas associated with milder desaturations or arousals.
关于睡眠呼吸紊乱后果的流行病学研究始终将呼吸暂停低通气指数作为疾病严重程度的主要衡量指标。尽管低通气构成了大多数呼吸紊乱事件，但对于用于定义这些事件的最佳标准仍存在重大争议。
当前的调查旨在评估与心血管疾病最相关的低通气的最合适定义。
招募了一个中年及老年成年人的社区样本作为睡眠心脏健康研究的一部分。进行了全导联多导睡眠图检查，并使用有无觉醒时不同的氧合血红蛋白去饱和阈值来定义低通气。基于自我报告评估心血管疾病的患病率。使用逻辑回归分析来描述低通气指数与心血管疾病患病率之间的独立关联。
利用一个包含6106名具有心血管疾病状态和多导睡眠图完整数据的成年人样本，本研究发现，与4%或更高的氧合血红蛋白去饱和相关的低通气与心血管疾病患病率相关，且不受混杂协变量的影响。使用4%去饱和标准时，低通气指数四分位数的调整后患病率比值比分别如下：1.00（<1.10次/小时），1.10（1.01 - 3.20次/小时），1.33（3.21 - 7.69次/小时），以及1.41（>7.69次/小时）。基于低于4%氧合血红蛋白去饱和或存在觉醒的低通气测量结果与心血管疾病无关联。
在普通社区中，低通气是睡眠呼吸紊乱的一个重要组成部分。通过改变定义低通气的标准，本研究表明，去饱和至少4%的低通气与心血管疾病独立相关。相比之下，未观察到心血管疾病与伴有较轻去饱和或觉醒的低通气之间存在关联。
