使用多导睡眠图对阻塞性睡眠呼吸暂停患者的咽病理生理学进行表型分析。
Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.
机构信息
1 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
2 Department of Allergy, Immunology and Respiratory Medicine, Melbourne, Victoria, Australia.
出版信息
Am J Respir Crit Care Med. 2018 May 1;197(9):1187-1197. doi: 10.1164/rccm.201707-1435OC.
RATIONALE
Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes ("traits") if a clinically applicable approach were available.
OBJECTIVES
Here we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography.
METHODS
Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g., during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in patients with OSA (N = 29), using a novel automated noninvasive method to estimate ventilatory drive (polysomnographic method) and using "gold standard" ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using continuous positive airway pressure manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N = 11).
MEASUREMENTS AND MAIN RESULTS
Polysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R = 0.83, P < 0.0001; and R = 0.76, P < 0.0001; respectively) and using continuous positive airway pressure manipulation (R = 0.67, P < 0.0001; and R = 0.64, P < 0.001; respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy, 69-86% vs. ventilatory drive measures; P < 0.05). Traits were near-identical using nasal pressure versus pneumotach (N = 11, R ≥ 0.98, both traits; P < 0.001).
CONCLUSIONS
Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling noninvasive phenotyping in the clinic. Our approach may facilitate precision therapeutic interventions for OSA.
原理
如果有一种临床适用的方法，治疗阻塞性睡眠呼吸暂停（OSA）的方法可以基于患者自身的表型原因（“特征”）。
目的
在这里，我们旨在提供一种量化两个关键贡献者的方法，即 OSA 咽壁塌陷和补偿性肌肉反应性，这对诊断多导睡眠图是适用的。
方法
基于生理定义，咽壁塌陷决定了睡眠期间正常（通气）通气驱动下的通气，咽壁补偿决定了随着通气驱动的升高而升高的通气。因此，测量通气和通气驱动（例如，在自发循环事件期间）应该可以揭示患者的表型特征，而无需专门干预。我们使用一种新的自动化无创方法来估计通气驱动（多导睡眠图法），并使用“金标准”通气驱动（食管内膈肌 EMG）进行比较，在 OSA 患者（N=29）中证明了这一概念。还使用连续气道正压通气操作进行了专门的生理测量，以进一步比较。还测试了鼻压作为通气替代物的有效性（N=11）。
测量和主要结果
多导睡眠图衍生的塌陷和补偿估计与使用金标准通气驱动（R=0.83，P<0.0001；和 R=0.76，P<0.0001；分别）和使用连续气道正压通气操作（R=0.67，P<0.0001；和 R=0.64，P<0.001；分别）量化的估计值密切相关。多导睡眠图估计有效地将患者分为高与低亚组（准确性，69-86%与通气驱动测量；P<0.05）。使用鼻压与测压计（N=11，R≥0.98，两种特征；P<0.001）时，特征几乎相同。
结论
OSA 中咽功能障碍的表型可以从睡眠期间通气和通气驱动的自发变化中明显看出，这使得在临床中能够进行无创表型分析。我们的方法可能有助于为 OSA 提供精确的治疗干预。
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