Fietze Ingo, Glos Martin, Zimmermann Sandra, Penzel Thomas
Charité-Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine.
J Clin Sleep Med. 2020 Feb 15;16(2):319-323. doi: 10.5664/jcsm.8192. Epub 2020 Jan 13.
Night-to-night variability (NNV) of the degree of obstructive sleep apnea (OSA) over the long term is not well investigated. In our case, we investigated the NNV of the apnea-hypopnea index (AHI) with regard to sleep structure. Unattended polysomnography (PSG) at home was used to determine the AHI in the course of 4 weeks in a single patient with a mild-to-moderate OSA, by using the Somnocheck R&K system. The mean sleep period was 6.7 ± 1.1 hours and the mean AHI was 14.1 ± 5.7 events/h (range: 5.1-28.3 events/h; coefficient variability [CV] 40.4%). Independent of non-rapid eye movement and rapid eye movement (REM) sleep, the AHI in supine position (43.6 ± 16.9 events/h; CV 38.8%) was greater than during lateral-recumbent sleep (4.8 ± 4.1 events/h; CV 85.4%, P < .0001). A negative correlation was found for both: the AHI in supine position with the duration of supine position sleep (r = .59, P < .001), as well as the AHI in REM with the duration of REM sleep (r = -.37, P < .025). The AHI shows no rhythmicity neither from day to day nor from week to week. We found a high long-term NNV of the AHI, which was typically not influenced by the particular day of the week. Supine AHI is evidently dependent on the duration spent in that position throughout the night. We found it advisable to consider the existence of NNV in association with the degree of OSA, especially for patients with questionable therapeutic indication.
长期以来，阻塞性睡眠呼吸暂停（OSA）程度的夜间变异性（NNV）尚未得到充分研究。在我们的案例中，我们研究了呼吸暂停低通气指数（AHI）的NNV与睡眠结构的关系。通过使用Somnocheck R&K系统，对一名轻度至中度OSA患者进行了为期4周的家庭无人值守多导睡眠图（PSG）检查，以确定AHI。平均睡眠时间为6.7±1.1小时，平均AHI为14.1±5.7次/小时（范围：5.1 - 28.3次/小时；变异系数[CV] 40.4%）。与非快速眼动睡眠和快速眼动（REM）睡眠无关，仰卧位时的AHI（43.6±16.9次/小时；CV 38.8%）高于侧卧位睡眠时（4.8±4.1次/小时；CV 85.4%，P <.0001）。仰卧位时的AHI与仰卧位睡眠时间之间（r =.59，P <.001）以及REM睡眠时的AHI与REM睡眠时间之间（r = -.37，P <.025）均呈负相关。AHI在日复一日或周复一周中均无节律性。我们发现AHI存在较高的长期NNV，且通常不受一周中特定日期的影响。仰卧位AHI显然取决于整夜处于该体位的时长。我们认为，尤其对于治疗指征存疑的患者，在考虑OSA程度时应考虑NNV的存在。
