Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China.
Pulmonary and Sleep Division, University of California at San Diego, California.
J Clin Sleep Med. 2017 Sep 15;13(9):1029-1037. doi: 10.5664/jcsm.6716.
To test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA).
In 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis.
Although preoperative loop gain was positively correlated with postoperative apnea-hypopnea index (AHI) ( = .008) and arousal threshold was negatively correlated ( = .011), in both model 1 and 2, the only significant variable was preoperative AHI, which explained 42% of the variance in postoperative AHI. In contrast, the physiological model (model 3), which included AHI (anatomy term), fraction of events that were hypopnea (arousal term), the ratio of AHI and AHI (muscle responsiveness term), loop gain, and central/mixed apnea index (control of breathing terms), was able to explain 61% of the variance in postoperative AHI.
Although loop gain and arousal threshold are associated with residual AHI after surgery, only preoperative AHI was predictive using multivariate regression modeling. Instead, incorporating selected surrogates of physiological traits on the basis of OSA pathophysiology created a model that has more association with actual residual AHI.
A commentary on this article appears in this issue on page 1023.
ClinicalTrials.Gov; Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea; Identifier: NCT02696629; URL: https://clinicaltrials.gov/show/NCT02696629.
测试在基于生理学的模型中整合解剖学和非解剖学参数（通气控制、觉醒阈值、肌肉反应性）是否能提高预测阻塞性睡眠呼吸暂停（OSA）患者上气道手术后结局的能力。
对 31 例行 OSA 上气道手术的患者，术前多导睡眠图（PSG）计算环路增益和觉醒阈值。比较三种模型：（1）基于 PSG 参数的多元回归；（2）使用 PSG 参数加上 PSG 衍生的环路增益、觉醒阈值和其他特质替代值的多元回归；（3）纳入选择变量的生理学模型，作为与 OSA 发病机制相关的解剖学和非解剖学特征的替代物。
尽管术前环路增益与术后呼吸暂停低通气指数（AHI）呈正相关（r=0.008），觉醒阈值与术后 AHI 呈负相关（r=-0.011），但在模型 1 和 2 中，唯一显著的变量是术前 AHI，其解释了术后 AHI 变化的 42%。相比之下，包括 AHI（解剖学参数）、呼吸暂停事件的分数（觉醒参数）、AHI 与 AHI 之比（肌肉反应性参数）、环路增益和中枢/混合呼吸暂停指数（呼吸控制参数）的生理学模型（模型 3），能够解释术后 AHI 变化的 61%。
尽管环路增益和觉醒阈值与术后残留 AHI 相关，但使用多元回归模型，只有术前 AHI 具有预测性。相反，基于 OSA 病理生理学纳入生理特征的选择替代物建立的模型与实际残留 AHI 更相关。
本文的一篇评论文章见本期第 1023 页。
ClinicalTrials.gov；标题：睡眠呼吸暂停治疗对中国阻塞性睡眠呼吸暂停患者生理特征的影响；标识符：NCT02696629；网址：https://clinicaltrials.gov/show/NCT02696629。
