在慢波睡眠中，阻塞性睡眠呼吸暂停严重程度明显减轻。
Marked reduction in obstructive sleep apnea severity in slow wave sleep.
机构信息
Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia.
出版信息
J Clin Sleep Med. 2009 Dec 15;5(6):519-24.
INTRODUCTION
Obstructive sleep apnea (OSA) is widely accepted to improve during slow wave sleep (SWS) compared to lighter stages of NREM sleep. However, supporting data to establish the magnitude and prevalence of this effect is lacking. Consequently, we examined this phenomenon, controlling for posture, in a large group of patients investigated for OSA at an academic clinical sleep service.
METHODS
A detailed retrospective analysis was conducted on data obtained from each 30-sec epoch of sleep in 253 consecutive full-night diagnostic polysomnography studies performed over a 3-month period. Respiratory and arousal event rates were calculated within each stage of sleep, in the supine and lateral postures, and across the whole night, with OSA patients classified on the basis of an overall apnea-hypopnea index (AHI) > or =15 events/h. Central sleep apnea (CSA) patients were defined by a central apnea index > 5/h. Sleep latency and time, and respiratory and arousal event rates in OSA, CSA, and non-OSA patients were compared between sleep stages and postures using linear mixed model analysis. The numbers of patients achieving reduced event rates in SWS and in the lateral posture were also examined.
RESULTS
There were 171 patients with OSA, 14 with CSA, and 68 non-OSA patients. OSA patients took significantly longer to achieve slow wave and REM sleep (p < 0.001) than non-OSA patients and had less stage 4 sleep (p = 0.037). There were striking improvements in AHI and arousal index (Al) from stage 1 to 4 NREM sleep (p <0.001), with intermediate levels in REM sleep. AHI and Al were also markedly reduced in lateral versus supine sleep in all sleep stages (p < 0.001), with an effect size comparable to that of the slow wave sleep effect. The majority of OSA patients achieved low respiratory event rates in SWS. Eighty-two percent of patients achieved an AHI <15 and 57% < 5 events/hour during stage 4 sleep.
CONCLUSION
Although OSA patients demonstrate both a delayed and reduced proportion of SWS compared to non-OSA subjects, once they achieved SWS, AHI, and Al markedly improved in most patients.
介绍
阻塞性睡眠呼吸暂停（OSA）在慢波睡眠（SWS）期间被广泛认为比非快速眼动（NREM）睡眠的更轻阶段有所改善。然而，缺乏支持这一效应程度和普遍性的数据。因此，我们在学术临床睡眠服务机构对 OSA 进行检查的一大组患者中，控制体位，检查了这一现象。
方法
对 3 个月期间进行的 253 例连续全夜诊断多导睡眠图研究的每 30 秒睡眠时段的睡眠数据进行了详细的回顾性分析。在仰卧位和侧卧位的各个睡眠阶段，以及整个夜间，计算呼吸和觉醒事件的发生率，并根据总的呼吸暂停-低通气指数（AHI）>或=15 次/小时将 OSA 患者进行分类。以中心性呼吸暂停指数> 5 次/小时将中枢性睡眠呼吸暂停（CSA）患者定义为 CSA 患者。使用线性混合模型分析比较 OSA、CSA 和非 OSA 患者在睡眠阶段和体位之间的睡眠潜伏期和时间、呼吸和觉醒事件率。还检查了 SWS 和侧卧位时事件发生率降低的患者数量。
结果
共有 171 例 OSA 患者、14 例 CSA 患者和 68 例非 OSA 患者。与非 OSA 患者相比，OSA 患者达到慢波和 REM 睡眠所需的时间明显更长（p <0.001），并且 4 期睡眠较少（p = 0.037）。从 NREM 睡眠 1 期到 4 期，AHI 和觉醒指数（Al）显著改善（p<0.001），在 REM 睡眠期间处于中间水平。在所有睡眠阶段，侧卧位与仰卧位相比，AHI 和 Al 也明显降低（p<0.001），其效果大小与慢波睡眠效果相当。大多数 OSA 患者在 SWS 中呼吸事件发生率较低。82%的患者在 4 期睡眠时 AHI<15，57%<5 次/小时。
结论
尽管与非 OSA 患者相比，OSA 患者表现出 SWS 延迟和比例降低，但一旦他们进入 SWS，大多数患者的 AHI 和 Al 明显改善。
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