Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia.
Eur Respir J. 2018 Jan 11;51(1). doi: 10.1183/13993003.01587-2017. Print 2018 Jan.
There is no satisfactory treatment for obstructive sleep apnoea (OSA). Supplemental low-flow oxygen therapy (LFO) has been shown to reduce hypoxaemia and is well tolerated by patients with OSA. However, oxygen therapy may be beneficial only to certain subsets of patients with OSA. In this study, we evaluated a 10-min awake ventilatory chemoreflex test in predicting individual OSA response to 2 months of LFO therapy.At baseline, patients with OSA underwent ventilatory chemoreflex testing in the afternoon, prior to the overnight polysomnography. Subjects were reassessed with polysomnography after 2 months of nocturnal oxygen treatment.20 patients with OSA completed the study. After 2 months of O treatment, changes in the apnoea-hypopnoea index (AHI) were significantly correlated with baseline CO ventilatory response threshold (VRT) and chemosensitivity (p<0.05). In predicting a fall in AHI, the area under the receiver operating characteristic curve (AUC) was 0.79 for VRT and 0.89 for chemosensitivity. When these two variables were combined in a logistic regression model, the prediction effect became stronger with an AUC of 0.97, sensitivity of 0.92 and specificity of 0.83.Our awake ventilatory chemoreflex test could be considered a simple potential clinical tool to predict individual OSA response to oxygen therapy. It could provide a novel personalised medicine approach to OSA treatment.
目前,阻塞性睡眠呼吸暂停(OSA)尚无满意的治疗方法。补充低流量氧气疗法(LFO)已被证明可减少低氧血症,且患者耐受性良好。然而,氧气治疗可能仅对 OSA 的某些亚组患者有益。在这项研究中,我们评估了 10 分钟清醒通气化学感受器反射试验,以预测个体 OSA 对 2 个月 LFO 治疗的反应。在基线时,OSA 患者在下午进行通气化学感受器反射试验,然后进行整夜多导睡眠图检查。在夜间氧疗 2 个月后,通过多导睡眠图对患者进行重新评估。20 例 OSA 患者完成了研究。经过 2 个月的 O 治疗后,呼吸暂停低通气指数(AHI)的变化与基线 CO 通气反应阈值(VRT)和化学敏感性显著相关(p<0.05)。在预测 AHI 下降方面,VRT 的受试者工作特征曲线(ROC)下面积(AUC)为 0.79,化学敏感性的 AUC 为 0.89。当这两个变量结合在逻辑回归模型中时,AUC 为 0.97,灵敏度为 0.92,特异性为 0.83,预测效果更强。我们的清醒通气化学感受器反射试验可以被认为是一种简单的潜在临床工具,可预测个体对氧疗的 OSA 反应。它可以为 OSA 治疗提供一种新的个体化医学方法。