饱和度降低的严重程度比 AHI 更能反映与 OSA 相关的日间嗜睡。
Severity of Desaturations Reflects OSA-Related Daytime Sleepiness Better Than AHI.
机构信息
Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland.
Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
出版信息
J Clin Sleep Med. 2019 Aug 15;15(8):1135-1142. doi: 10.5664/jcsm.7806.
STUDY OBJECTIVES
The aim was to investigate how the severity of apneas, hypopneas, and related desaturations is associated with obstructive sleep apnea (OSA)-related daytime sleepiness.
METHODS
Multiple Sleep Latency Tests and polysomnographic recordings of 362 patients with OSA were retrospectively analyzed and novel diagnostic parameters (eg, obstruction severity and desaturation severity), incorporating severity of apneas, hypopneas, and desaturations, were computed. Conventional statistical analysis and multivariate analyses were utilized to investigate connection of apnea-hypopnea index (AHI), oxygen desaturation index (ODI), conventional hypoxemia parameters, and novel diagnostic parameters with mean daytime sleep latency (MSL).
RESULTS
In the whole population, 10% increase in values of desaturation severity (risk ratio = 2.01, P < .001), obstruction severity (risk ratio = 2.18, P < .001) and time below 90% saturation (t) (risk ratio = 2.05, P < .001) induced significantly higher risk of having mean daytime sleep latency ≤ 5 minutes compared to 10% increase in AHI (risk ratio = 1.63, P < .05). In severe OSA, desaturation severity had significantly (P < .02) stronger negative correlation (ρ = -.489, P < .001) with mean daytime sleep latency compared to AHI (ρ = -.402, P < 0.001) and ODI (ρ = -.393, P < .001). Based on general regression model, desaturation severity and male sex were the most significant factors predicting daytime sleep latency.
CONCLUSIONS
Severity of sleep-related breathing cessations and desaturations is a stronger contributor to daytime sleepiness than AHI or ODI and therefore should be included in the diagnostics and severity assessment of OSA.
CITATION
Kainulainen S, Töyräs J, Oksenberg A, Korkalainen H, Sefa S, Kulkas A, Leppänen T. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med. 2019;15(8):1135-1142.
研究目的
本研究旨在探讨睡眠呼吸暂停（OSA）相关的日间嗜睡与呼吸暂停、低通气和相关脱氧的严重程度之间的关系。
方法
回顾性分析了 362 例 OSA 患者的多次睡眠潜伏期试验和多导睡眠图记录，并计算了包含呼吸暂停、低通气和脱氧严重程度的新型诊断参数（如阻塞严重程度和脱氧严重程度）。利用常规统计学分析和多元分析来研究呼吸暂停-低通气指数（AHI）、氧减指数（ODI）、传统低氧血症参数和新型诊断参数与日间平均睡眠潜伏期（MSL）之间的关系。
结果
在整个人群中，脱氧严重程度增加 10%（风险比=2.01，P<0.001）、阻塞严重程度增加 10%（风险比=2.18，P<0.001）和 t 以下 90%饱和度时间增加 10%（风险比=2.05，P<0.001），与 AHI 增加 10%相比，MSL≤5 分钟的风险显著增加（风险比=1.63，P<0.05）。在严重 OSA 中，脱氧严重程度与 MSL 呈显著负相关（ρ=-0.489，P<0.001），明显强于 AHI（ρ=-0.402，P<0.001）和 ODI（ρ=-0.393，P<0.001）。基于一般回归模型，脱氧严重程度和男性是预测日间睡眠潜伏期的最重要因素。
结论
与 AHI 或 ODI 相比，睡眠相关呼吸暂停和脱氧的严重程度对日间嗜睡的影响更大，因此应纳入 OSA 的诊断和严重程度评估中。
参考文献
Kainulainen S, Töyräs J, Oksenberg A, Korkalainen H, Sefa S, Kulkas A, Leppänen T. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med. 2019;15(8):1135-1142.
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