Prasad Bharati, Usmani Sarah, Steffen Alana D, Van Dongen Hans P A, Pack Francis M, Strakovsky Inna, Staley Bethany, Dinges David, Maislin Greg, Pack Allan I, Weaver Terri E
Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL.
Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago.
J Clin Sleep Med. 2016 Jun 15;12(6):855-63. doi: 10.5664/jcsm.5886.
Apnea-hypopnea index (AHI) is the primary measure used to confirm a diagnosis of obstructive sleep apnea (OSA). However, there may be significant night-to-night variability (NNV) in AHI, limiting the value of AHI in clinical decision-making related to OSA management. We examined short-term NNV in AHI and its predictors during home portable monitoring (PM).
Single center prospective observational study of patients (n = 84) with newly diagnosed OSA by polysomnography (PSG) AHI ≥ 5/h. All participants underwent 2 to 8 consecutive nights of PM.
Participants (n = 84) were middle-aged (47 ± 8.3 y, mean ± standard deviation; SD), including 28 women, with mean AHI on baseline PSG (AHIPSG) of 30.1 ± 31.8. Mean AHI on PM (AHIPM) was 27.4 ± 23.7. Intraclass correlation coefficient (ICC) for AHIPM in the entire sample was 0.73 (95% CI 0.66-0.8), indicating that 27% of the variability in AHIPM was due to intra-individual factors. Mild severity of OSA, defined by AHIPSG 5-15/h, was associated with higher NNV (likelihood ratio, -0.4 ± 0.14; p = 0.006) and absence of comorbidity showed a trend towards higher NNV (-0.54 ± 0.27, p = 0.05) on AHIPM.
The intraindividual short-term NNV in AHIPM is higher in mild versus moderately severe OSA, even in the home setting, where first-night effect is not expected. Larger studies of NNV focused on patients with mild OSA are needed to identify characteristics that predict need and timing for repeated diagnostic testing and treatment.
A commentary on this article appears in this issue on page 787.
呼吸暂停低通气指数（AHI）是用于确诊阻塞性睡眠呼吸暂停（OSA）的主要指标。然而，AHI可能存在显著的夜间变异性（NNV），这限制了AHI在OSA管理相关临床决策中的价值。我们研究了家庭便携式监测（PM）期间AHI的短期NNV及其预测因素。
对经多导睡眠图（PSG）检查确诊为新发性OSA且AHI≥5次/小时的患者（n = 84）进行单中心前瞻性观察研究。所有参与者连续进行2至8晚的PM监测。
参与者（n = 84）为中年人群（47±8.3岁，均值±标准差；SD），其中包括28名女性，基线PSG（AHIPSG）的平均AHI为30.1±31.8。PM时的平均AHI（AHIPM）为27.4±23.7。整个样本中AHIPM的组内相关系数（ICC）为0.73（95%CI 0.66 - 0.8），这表明AHIPM中27%的变异性是由个体内部因素导致的。由AHIPSG 5 - 15次/小时定义的轻度OSA严重程度与更高的NNV相关（似然比，-0.4±0.14；p = 0.006），并且在AHIPM上，无合并症显示出更高NNV的趋势（-0.54±0.27，p = 0.05）。
即使在家庭环境中（预计不存在首夜效应），轻度OSA患者AHIPM的个体内短期NNV也高于中度至重度OSA患者。需要针对轻度OSA患者进行更大规模的NNV研究，以确定预测重复诊断测试和治疗需求及时机的特征。
关于本文的述评发表在本期第787页。
