在睡眠实验室环境中进行的呼出气一氧化氮分数测定和阻塞性睡眠呼吸暂停筛查：一项横断面研究。
Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study.
机构信息
Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Avenida das Américas 4666, sala 309, Barra da Tijuca, Rio de Janeiro, 22649-900, Brazil.
Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
出版信息
Lung. 2019 Apr;197(2):131-137. doi: 10.1007/s00408-018-0190-y. Epub 2019 Jan 2.
PURPOSE
Obstructive sleep apnea (OSA) is a common condition characterized by repetitive collapse of the upper airways and intermittent oxygen desaturation, which may lead to airway inflammation. Here, we explored whether fractional exhaled nitric oxide (FeNO) levels provide a non-invasive screening tool of OSA.
METHODS
Over a 3-month period, FeNO levels were measured in consecutive non-smoking patients referred for a sleep laboratory. All patients underwent full polysomnography. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate/severe OSA, and ≥ 30.0/h as severe OSA. FeNO was measured by a portable device (NIOX-MINO®; Aerocrine AB, Solna, Sweden) and expressed as parts per billion (ppb). Discrimination by area under the curve (AUC) and binary logistic regression were performed.
RESULTS
A total of 229 subjects were evaluated. Mean FeNO values were similar among subjects without OSA or with OSA: 16.9 ± 10.6 ppb versus 20.2 ± 14.5 ppb, p = 0.221; respectively. FeNO was not an inclusionary parameter to predict any OSA, moderate/severe OSA, and severe OSA: odds ratio (OR) 1.023 (95% confidence interval [CI]: 0.986-1.062); OR 1.012 (95% CI: 0.991-1.034); and OR 0.999 (95% CI: 0.980-1.018), respectively. The AUC values for FeNO in the diagnosis of any OSA, moderate/severe OSA, and severe OSA showed no discriminatory properties: AUC: 0.567 (95% CI: 0.464-0.670), AUC: 0.541 (95% CI: 0.465-0.618), and AUC: 0.535 (95% CI: 0.459-0.610); respectively.
CONCLUSIONS
In a sleep-lab setting, our findings suggest that FeNO measurements are inconsequential in the screening of OSA in adults.
目的
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，其特征为上呼吸道反复塌陷和间歇性缺氧，这可能导致气道炎症。在这里，我们探讨了呼出气一氧化氮分数（FeNO）水平是否可作为 OSA 的非侵入性筛查工具。
方法
在 3 个月期间，对连续就诊睡眠实验室的非吸烟患者进行了 FeNO 水平测量。所有患者均接受了全面的多导睡眠图检查。根据呼吸暂停/低通气指数对 OSA 严重程度进行分类：≥5.0/h 为任何 OSA，≥15.0/h 为中重度/重度 OSA，≥30.0/h 为重度 OSA。FeNO 采用便携式设备（NIOX-MINO®；Aerocrine AB，Solna，瑞典）进行测量，以十亿分之几（ppb）表示。采用曲线下面积（AUC）和二元逻辑回归进行判别。
结果
共评估了 229 例患者。无 OSA 或 OSA 患者的平均 FeNO 值相似：16.9±10.6 ppb 与 20.2±14.5 ppb，p=0.221；分别。FeNO 不是预测任何 OSA、中重度/重度 OSA 和重度 OSA 的纳入参数：比值比（OR）1.023（95%置信区间[CI]：0.986-1.062）；OR 1.012（95% CI：0.991-1.034）；和 OR 0.999（95% CI：0.980-1.018）。FeNO 诊断任何 OSA、中重度/重度 OSA 和重度 OSA 的 AUC 值均无鉴别特性：AUC：0.567（95% CI：0.464-0.670），AUC：0.541（95% CI：0.465-0.618），AUC：0.535（95% CI：0.459-0.610）。
结论
在睡眠实验室环境中，我们的研究结果表明，FeNO 测量对成人 OSA 的筛查无关紧要。
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