不同的低通气定义会影响阻塞性睡眠呼吸暂停严重程度的分类，并与心血管疾病相关。
Varying Hypopnea Definitions Affect Obstructive Sleep Apnea Severity Classification and Association With Cardiovascular Disease.
机构信息
Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut.
Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
出版信息
J Clin Sleep Med. 2018 Dec 15;14(12):1987-1994. doi: 10.5664/jcsm.7520.
STUDY OBJECTIVES
To compare clinical features and cardiovascular risks in patients with obstructive sleep apnea (OSA) based on ≥ 3% desaturation or arousal, and ≥ 4% desaturation hypopnea criteria.
METHODS
This is a cross-sectional analysis of 1,400 veterans who underwent polysomnography for suspected sleep-disordered breathing. Hypopneas were scored using ≥ 4% desaturation criteria per the American Academy of Sleep Medicine (AASM) 2007 guidelines, then re-scored using ≥ 3% desaturation or arousal criteria per AASM 2012 guidelines. The effect on OSA disease categorization by these two different definitions were compared and correlated with symptoms and cardiovascular associations using unadjusted and adjusted logistic regression.
RESULTS
The application of the ≥ 3% desaturation or arousal definition of hypopnea captured an additional 175 OSA diagnoses (12.5%). This newly diagnosed OSA group (OSA) was symptomatic with daytime sleepiness similarly to those in whom OSA had been diagnosed based on ≥ 4% desaturation criteria (OSA). The OSA group was more obese and more likely to be male than those without OSA based on either criterion (No-OSA). However, the OSA group was younger, less obese, more likely female, and had a lesser smoking history compared to the OSA group. Those with any severity of OSA had an increased adjusted odds ratio for arrhythmias (odds ratio = 1.95 [95% confidence interval 1.37-2.78], = .0155). The more inclusive hypopnea definition (ie, ≥ 3% desaturation or arousal) resulted in recategorization of OSA diagnosis and severity, and attenuated the increased odds ratio for arrhythmias observed in mild and moderate OSA. However, severe OSA based on ≥ 3% desaturation or arousals (OSA3%/Ar) remained a significant risk factor for arrhythmias. OSA based on any definition was not associated with ischemic heart disease or heart failure.
CONCLUSIONS
The most current AASM criteria for hypopnea identify a unique group of patients who are sleepy, but who are not at increased risk for cardiovascular disease. Though the different hypopnea definitions result in recategorization of OSA severity, severe disease whether defined by ≥ 3% desaturation/arousals or ≥ 4% desaturation remains predictive of cardiac arrhythmias.
COMMENTARY
A commentary on this article appears in this issue on page 1971.
研究目的
比较基于≥3% 血氧饱和度下降或觉醒以及≥4% 血氧饱和度下降低通气标准的阻塞性睡眠呼吸暂停（OSA）患者的临床特征和心血管风险。
方法
这是一项对 1400 名接受疑似睡眠呼吸障碍多导睡眠图检查的退伍军人进行的横断面分析。根据美国睡眠医学学会（AASM）2007 年指南，使用≥4% 血氧饱和度下降标准对低通气进行评分，然后根据 AASM 2012 年指南使用≥3% 血氧饱和度下降或觉醒标准重新评分。比较这两种不同定义对 OSA 疾病分类的影响，并使用未经调整和调整后的逻辑回归分析与症状和心血管关联进行相关性分析。
结果
应用≥3% 血氧饱和度下降或觉醒的低通气定义可额外诊断 175 例 OSA（12.5%）。新诊断的 OSA 组（OSA）与基于≥4% 血氧饱和度下降标准诊断为 OSA 的患者一样存在日间嗜睡症状。与基于任何一种标准的非 OSA 组相比，OSA 组更肥胖，更可能为男性。然而，与 OSA 组相比，OSA 组年龄更小，肥胖程度更低，更可能为女性，吸烟史更少。任何严重程度的 OSA 患者的心律失常校正后比值比均增加（比值比=1.95[95%置信区间 1.37-2.78]，P=0.0155）。更具包容性的低通气定义（即，≥3% 血氧饱和度下降或觉醒）导致 OSA 诊断和严重程度的重新分类，并减弱了轻度和中度 OSA 中观察到的心律失常风险比的增加。然而，基于≥3% 血氧饱和度下降或觉醒的严重 OSA（OSA3%/Ar）仍然是心律失常的一个重要危险因素。基于任何定义的 OSA 均与缺血性心脏病或心力衰竭无关。
结论
当前最先进的 AASM 低通气标准确定了一组嗜睡但无心血管疾病风险增加的独特患者。尽管不同的低通气定义导致 OSA 严重程度的重新分类，但无论是否通过≥3% 血氧饱和度下降/觉醒或≥4% 血氧饱和度下降来定义，严重疾病仍然可预测心脏心律失常。
注释
本文的一篇评论文章发表在本期第 1971 页。
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