Department of Psychiatry and Sleep Clinic Himalayan, Institute of Medical Sciences, Swami Ram Nagar, Doiwala, 248140, Dehradun, India,
Neurol Sci. 2013 Sep;34(9):1543-50. doi: 10.1007/s10072-012-1281-9. Epub 2013 Jan 3.
Our clinical experience suggested existence of a third group, stage-independent-OSA besides two known groups: REM-dependent-OSA and NREM-dependent-OSA. This study was planned to compare the characteristics of this group with the other two. All the subjects undergoing diagnostic video-polysomnographies with AHI >5/h were included in this study. Based upon the ratio of AHI during REM and NREM sleep, various groups were formed. REM-dependent-OSA was defined as AHI-REM/AHI-NREM >2; all other subjects were included in Not-REM-dependent-OSA (A-1 analysis). This group was further bifurcated into two groups: Non-REM-dependent OSA (NREM-dependent-OSA) where AHI-NREM/AHI-REM >2 and remaining subjects were included in the sleep-stage-independent-OSA group (A-2 analysis). SPSS v 17.0 was used to calculate independent sample t test (A-1 analysis) and Kruskall-Wallis test (A-2 analysis). Using A-1 approach, REM-dependent-OSA group was found to be suffering from mild-moderate OSA (90 %). REM-dependent OSA group had lower AHI-NREM (P < 0.001; 95 % CI 22.11-36.81) and lower AHI-total (P < 0.001; 95 % CI 15.39-30.73). Surprisingly, AHI-REM and DI-REM were not significantly different between these groups. A-2 analysis showed that overall, REM-dependent-OSA had lowest AHI-total while the stage-independent group had highest (P < 0.001). However, on analysis of REM-dependent-OSA, it was found that few of the subjects from this group had severe OSA (AHI-total > 30/h). The NREM-AHI increased linearly as we moved from REM-dependent-OSA to stage-independent-OSA with a significant difference across groups (P < 0.001). However, similar trend was not observed for AHI-REM. This study showed that a third group, sleep-stage-independent-OSA also exists when OSA is classified according to the proportion of apnea across sleep stages. This classification partially corresponds with the severity of illness.
我们的临床经验表明，除了 REM 依赖性 OSA 和 NREM 依赖性 OSA 这两个已知的组别之外，还存在第三个组别，即与睡眠期无关的 OSA。本研究旨在比较该组与其他两组的特征。所有接受 AHI＞5/h 的诊断视频多导睡眠图检查的患者均纳入本研究。根据 REM 和 NREM 睡眠期间 AHI 的比值，将患者分为不同组别。REM 依赖性 OSA 定义为 AHI-REM/AHI-NREM＞2；其余患者均纳入非 REM 依赖性 OSA（A-1 分析）。该组进一步分为两组：非 REM 依赖性 OSA（NREM 依赖性 OSA），其 AHI-NREM/AHI-REM＞2；其余患者纳入与睡眠期无关的 OSA 组（A-2 分析）。采用 SPSS v 17.0 计算独立样本 t 检验（A-1 分析）和 Kruskal-Wallis 检验（A-2 分析）。采用 A-1 分析方法，发现 REM 依赖性 OSA 组患者患有轻中度 OSA（90%）。REM 依赖性 OSA 组的 NREM 期 AHI 较低（P＜0.001；95%CI 22.11-36.81），总 AHI 较低（P＜0.001；95%CI 15.39-30.73）。令人惊讶的是，这些组之间的 REM 期 AHI 和 REM 期呼吸暂停低通气指数并无显著差异。A-2 分析显示，总体而言，REM 依赖性 OSA 的总 AHI 最低，而与睡眠期无关的组最高（P＜0.001）。然而，对 REM 依赖性 OSA 进行分析时发现，该组中有少数患者患有严重的 OSA（总 AHI＞30/h）。随着从 REM 依赖性 OSA 到与睡眠期无关的 OSA，NREM-AHI 呈线性增加，各组之间存在显著差异（P＜0.001）。然而，对于 REM 期 AHI，并未观察到类似的趋势。本研究表明，当根据睡眠期呼吸暂停的比例对 OSA 进行分类时，也存在第三个组别，即与睡眠期无关的 OSA。这种分类方法与疾病的严重程度部分相关。
