Genta Pedro R, Schorr Fabiola, Edwards Bradley A, Wellman Andrew, Lorenzi-Filho Geraldo
Laboratorio do Sono, LIM 63, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Victoria, Australia.
J Clin Sleep Med. 2020 Sep 15;16(9):1531-1537. doi: 10.5664/jcsm.8600.
Although obstructive sleep apnea results from the combination of different pathophysiologic mechanisms, the degree of anatomical compromise remains the main responsible factor. The passive pharyngeal critical closing pressure (Pcrit) is a technique used to assess the collapsibility of the upper airway and is often used as a surrogate measure of this anatomical compromise. Patients with a low Pcrit (ie, less collapsible airway) are potential candidates for non-continuous positive airway pressure therapies. However, Pcrit determination is a technically complex method not available in clinical practice. We hypothesized that the discrimination between low and high Pcrit can be estimated from simple anthropometric and polysomnographic indices.
Men with and without obstructive sleep apnea underwent Pcrit determination and full polysomnography. Receiver operating characteristics analysis was performed to select the best cutoff of each variable to predict a high Pcrit (Pcrit ≥ 2.5 cmH₂O). Multiple logistic regression analysis was performed to create a clinical score to predict a high Pcrit.
We studied 81 men, 48 ± 13 years of age, with an apnea-hypopnea index of 32 [14-60], range 1-96 events/h), and Pcrit of -0.7 ± 3.1 (range, -9.1 to +7.2 cmH₂O). A high and low Pcrit could be accurately identified by polysomnographic and anthropometric indices. A score to discriminate Pcrit showed good performance (area under the curve = 0.96; 95% confidence interval, 0.91-1.00) and included waist circumference, non-rapid eye movement obstructive apnea index/apnea-hypopnea index, mean obstructive apnea duration, and rapid eye movement apnea-hypopnea index.
A low Pcrit (less collapsible) can be estimated from a simple clinical score. This approach may identify candidates more likely to respond to non-continuous positive airway pressure therapies for obstructive sleep apnea.
尽管阻塞性睡眠呼吸暂停是由不同病理生理机制共同作用导致的，但解剖结构受损程度仍是主要的致病因素。被动咽部临界闭合压（Pcrit）是一种用于评估上气道可塌陷性的技术，常被用作这种解剖结构受损情况的替代指标。Pcrit值较低（即气道不易塌陷）的患者是无创持续气道正压通气治疗的潜在适用对象。然而，Pcrit测定是一种技术复杂的方法，临床实践中无法采用。我们推测，可通过简单的人体测量和多导睡眠图指标来评估Pcrit的高低。
对患有和未患有阻塞性睡眠呼吸暂停的男性进行Pcrit测定和全面的多导睡眠图检查。进行受试者工作特征分析，以选择每个变量预测高Pcrit（Pcrit≥2.5 cmH₂O）的最佳临界值。进行多因素逻辑回归分析，以创建一个预测高Pcrit的临床评分。
我们研究了81名年龄在48±13岁的男性，其呼吸暂停低通气指数为32 [14 - 60]，范围为1 - 96次/小时，Pcrit为-0.7±3.1（范围为-9.1至+7.2 cmH₂O）。多导睡眠图和人体测量指标能够准确识别Pcrit的高低。用于区分Pcrit的评分表现良好（曲线下面积 = 0.96；95%置信区间，0.91 - 1.00），包括腰围、非快速眼动期阻塞性呼吸暂停指数/呼吸暂停低通气指数、平均阻塞性呼吸暂停持续时间和快速眼动期呼吸暂停低通气指数。
可通过简单的临床评分来评估低Pcrit（不易塌陷）情况。这种方法可能有助于识别更有可能对阻塞性睡眠呼吸暂停的无创持续气道正压通气治疗产生反应的患者。
