基于多导睡眠图测量的阻塞性睡眠呼吸暂停综合征严重程度新指标——对阻塞性睡眠呼吸暂停综合征的不同视角
New Indices from Polysomnographic Measures for the Severity of Obstructive Sleep Apnea Syndrome -A Different Look at Obstructive Sleep Apnea Syndrome.
作者信息
Demır Nurhak, Öztura İbrahim
机构信息
Marmara University, Pendik Education and Research Hospital, Neurology Clinic, İstanbul, Turkey.
Department of Neurology, Dokuz Eylül University Hospital, İzmir, Turkey.
出版信息
Noro Psikiyatr Ars. 2019 Aug 7;57(3):222-227. doi: 10.29399/npa.23118. eCollection 2020 Sep.
INTRODUCTION
Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent abnormal respiratory events during sleep and causes oxidative stress which is reported as a major pathogenic mechanism for the development of various cardiovascular disorders. For the diagnosis and management of treatment, disease-related symptoms and the Apnea-Hypopnea Index (AHI) measured from polysomnographic (PSG) recordings are taken together. However, AHI do not sufficiently represent the total hypoxic load, and other indices related to apnea frequency, apnea duration, and desaturation degree should be investigated.
METHODS
In this study, 317 polysomnographic recordings were retrospectively evaluated. Apart from the conventional AHI, apnea and/or hypopnea duration percentage (AHDP) and desaturation area (DesatArea) were calculated using PSG data.
RESULTS
According to the AHI, 21.8%, 32.8% and 45.4% of cases were grouped as mild, moderate and severe OSAS, respectively. When AHDP was taken into account, 10.4%, 22.1% and 67.5% of the cases were regrouped as mild, moderate or severe OSAS, respectively. When the DesatArea calculation was used, the grouping of cases as mild, moderate or severe OSAS changed in value to 10.7%, 21.1% and 68.1%, respectively. The total group change was found to be 58.4% for both the AHDP and DesatArea formulation. With the AHDP formulation, regrouping was made in 52.2% of the mild OSAS cases and 62.5% of the moderate OSAS cases; by using the DesatArea calculation, 50.7% of mild OSAS cases and 63% of moderate OSAS cases were regrouped.
CONCLUSION
Our results show that when another parameters related to abnormal respiratory events are used, the same patients within the same group of disease severity are heterogeneously separated according to severity of hypoxia. It is suggested that grouping the patients based on AHI is insufficient and that using other polysomnographic measurements along with AHI should be considered to represent the severity of the disease.
引言
阻塞性睡眠呼吸暂停综合征（OSAS）的特征是睡眠期间反复出现异常呼吸事件，并导致氧化应激，这被认为是各种心血管疾病发生的主要致病机制。对于该疾病的诊断和治疗管理，通常综合考虑与疾病相关的症状以及通过多导睡眠图（PSG）记录测得的呼吸暂停低通气指数（AHI）。然而，AHI并不能充分反映总的缺氧负荷，因此应研究与呼吸暂停频率、呼吸暂停持续时间和血氧饱和度下降程度相关的其他指标。
方法
本研究对317份多导睡眠图记录进行了回顾性评估。除了传统的AHI外，还利用PSG数据计算了呼吸暂停和/或低通气持续时间百分比（AHDP）以及血氧饱和度下降面积（DesatArea）。
结果
根据AHI，分别有21.8%、32.8%和45.4%的病例被归类为轻度、中度和重度OSAS。若考虑AHDP，则分别有10.4%、22.1%和67.5%的病例被重新归类为轻度、中度或重度OSAS。使用DesatArea计算时，轻度、中度或重度OSAS病例的分组比例分别变为10.7%、21.1%和68.1%。发现AHDP和DesatArea公式的总体分组变化均为58.4%。采用AHDP公式时，52.2%的轻度OSAS病例和62.5%的中度OSAS病例被重新分组；使用DesatArea计算时，50.7%的轻度OSAS病例和63%的中度OSAS病例被重新分组。
结论
我们的结果表明，当使用与异常呼吸事件相关的其他参数时，同一疾病严重程度组内的相同患者会根据缺氧严重程度被异质性地分开。这表明仅基于AHI对患者进行分组是不够的，应考虑将AHI与其他多导睡眠图测量结果一起使用，以更准确地反映疾病的严重程度。
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