Department of Respiratory Medicine, Gosford Hospital, Gosford, New South Wales, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Respirology. 2017 Jul;22(5):1015-1021. doi: 10.1111/resp.13022. Epub 2017 Mar 16.
Ethnic differences in obstructive sleep apnoea (OSA) phenotype may not be limited to obesity and craniofacial factors. The aims of the study were to (i) compare the proportion of Caucasians and Chinese patients with a low respiratory arousal threshold (ArTH) and (ii) explore the influence of anatomical compromise on ArTH.
Interethnic comparison was conducted between cohorts of Caucasian and Chinese patients from specialist sleep disorder clinics. Polysomnography and craniofacial photography were performed. A low respiratory ArTH was determined by an ArTH score of 2 or above (one point for each: apnoea-hypopnoea index (AHI) < 30/h, nadir oxygen saturation (SaO ) > 82.5%, fractions of hypopnoeas > 58.3%). Anatomical compromise was stratified according to the photographic face width measurement.
A total of 348 subjects (163 Caucasians and 185 Chinese) were analysed. There was a significantly lower proportion of Chinese patients with moderate-severe OSA (AHI ≥ 15) who had a low ArTH (28.4% vs 48.8%, P = 0.004). This difference remained significant among those with severe OSA (AHI ≥ 30) (2.6% vs 17.1%, P = 0.02). The proportion of moderate-severe OSA Caucasians with a low ArTH was significantly less in those with severe anatomical compromise (36.6% vs 61.0%, P = 0.03), whereas there was no difference in Chinese patients (25.5% vs 31.5%, P = 0.49).
Compared to Caucasians with severe OSA, a low respiratory ArTh appears to be a less common pathophysiological mechanism in Chinese patients. Caucasians with less severe anatomical compromise exhibit evidence of a lower ArTh, an association which is absent in Chinese patients. Our data suggest that OSA mechanisms may vary across racial groups.
阻塞性睡眠呼吸暂停（OSA）表型的种族差异可能不仅局限于肥胖和颅面因素。本研究的目的是：（i）比较白种人和中国患者中低呼吸唤醒阈值（ArTH）的比例；（ii）探讨解剖结构异常对 ArTH 的影响。
对来自专科睡眠障碍诊所的白种人和中国患者队列进行了种间比较。进行了多导睡眠图和颅面摄影。低呼吸 ArTH 通过 ArTH 评分 2 或以上来确定（每个评分点为：呼吸暂停低通气指数（AHI）<30/h，最低血氧饱和度（SaO ）>82.5%，低通气分数>58.3%）。根据照片面部宽度测量值对解剖结构异常进行分层。
共分析了 348 例患者（163 例白种人和 185 例中国人）。AHI≥15 的中重度 OSA 患者中，中国患者低 ArTH 的比例明显较低（28.4% vs 48.8%，P=0.004）。在 AHI≥30 的重度 OSA 患者中，这种差异仍然显著（2.6% vs 17.1%，P=0.02）。严重解剖结构异常的中重度 OSA 白种人低 ArTH 比例明显较低（36.6% vs 61.0%，P=0.03），而中国患者则无差异（25.5% vs 31.5%，P=0.49）。
与重度 OSA 的白种人相比，低呼吸 ArTh 似乎是中国患者中一种不太常见的病理生理机制。严重解剖结构异常程度较低的白种人表现出较低的 ArTh，而中国患者则没有这种关联。我们的数据表明，OSA 机制可能因种族群体而异。
