无低氧血症的呼吸紊乱与睡眠呼吸暂停时的客观嗜睡相关。
Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea.
作者信息
Koch Henriette, Schneider Logan Douglas, Finn Laurel A, Leary Eileen B, Peppard Paul E, Hagen Erika, Sorensen Helge Bjarup Dissing, Jennum Poul, Mignot Emmanuel
机构信息
Department of Psychiatry and Behavioral Medicine, Stanford University Center for Sleep Sciences and Medicine, Stanford University, CA.
Department of Electrical Engineering, Biomedical Engineering, Technical University of Denmark, Lyngby, Denmark.
出版信息
Sleep. 2017 Nov 1;40(11). doi: 10.1093/sleep/zsx152.
STUDY OBJECTIVES
To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.
METHODS
A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.
RESULTS
H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.
CONCLUSIONS
In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.
研究目的
确定定义睡眠呼吸障碍（SDB）事件的两种亚型（伴有或不伴有低氧血症）是否会产生与高血压和嗜睡更密切相关的指标。
方法
利用我们开发的自动算法，对来自威斯康星睡眠队列的1022名参与者的2112份夜间多导睡眠图进行分析，该算法用于检测呼吸紊乱和血氧饱和度下降情况。呼吸事件与血氧饱和度下降情况进行时间锁定，从而得出两个指标——有血氧饱和度下降的（低氧血症-呼吸紊乱指数 [H-BDI]）和无血氧饱和度下降的（非低氧血症-呼吸紊乱指数 [NH-BDI]）事件，无论是否伴有觉醒。除了临床相关的人口统计学变量外，还分析了主观（爱泼沃斯嗜睡量表）和客观（来自865名参与者子集的2981次多次睡眠潜伏期测试）嗜睡情况。高血压定义为血压≥140/90或正在使用抗高血压药物。
结果
H-BDI与包括低氧血症的SDB严重程度指标密切相关，但NH-BDI并非如此（与3%氧饱和度下降指数 [ODI] 和伴有4%饱和度下降的呼吸暂停低通气指数的相关性r≥0.89，p≤0.001）。与饱和度下降相关事件增加一倍与高血压患病率相关，这在ODI中具有统计学意义，但在H-BDI中无统计学意义（3% ODI比值比=1.06，95%置信区间=1.00-1.12，p<0.05；H-BDI比值比1.04，95%置信区间=0.98-1.10），且与白天嗜睡相关（爱泼沃斯嗜睡量表 [ESS] 评分β=0.20，p<0.0001；多次睡眠潜伏期测试 [MSLT] 中MSL的β=-0.20分钟，p<0.01）。单独来看，无饱和度下降事件增加一倍与更客观的嗜睡相关（MSLT中MSL的β=-0.52分钟，p<0.001），但与主观嗜睡的相关性较小（ESS评分β=0.12，p=0.10）。在纵向分析中，基线无饱和度下降事件与4年随访期间H-BDI的恶化相关，提示严重程度的演变。
结论
在SDB中，无饱和度下降事件独立于有饱和度下降事件的影响，与客观的白天嗜睡相关。
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