Joosten Simon A, Landry Shane A, Wong Ai-Ming, Mann Dwayne L, Terrill Philip I, Sands Scott A, Turton Anthony, Beatty Caroline, Thomson Luke, Hamilton Garun S, Edwards Bradley A
Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia; The School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Monash Partners-Epworth, Victoria, Australia.
Monash Lung and Sleep, Monash Medical Centre, Clayton, VIC, Australia; Department of Physiology, Monash University, Melbourne, VIC, Australia; School of Biomedical Sciences and Biomedical Discovery Institute, and the Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.
Chest. 2021 May;159(5):1998-2007. doi: 10.1016/j.chest.2020.10.080. Epub 2020 Nov 14.
Patients with OSA can have the majority of their respiratory events in rapid eye movement (REM) sleep or in non-rapid eye movement (NREM) sleep. No previous studies have linked the different physiologic conditions in REM and NREM sleep to the common polysomnographic patterns seen in everyday clinical practice, namely REM predominant OSA (REM) and NREM predominant OSA (NREM).
(1) How does OSA physiologic condition change with sleep stage in patients with NREM and REM? (2) Do patients with NREM and REM have different underlying OSA pathophysiologic conditions?
We recruited patients with three polysomnographic patterns. (1) REM: twice as many respiratory events in REM sleep, (2) NREM: twice as many events in NREM sleep, and (3) uniform OSA: equal number of events in NREM/REM sleep. We deployed a noninvasive phenotyping method to determine OSA endotype traits (Vpassive, Vactive, loop gain, arousal threshold) in NREM sleep, REM sleep, and total night sleep in each group of patients (NREM, REM, uniform OSA).
Patients with NREM have significantly worse ventilatory control stability in NREM sleep compared with REM sleep (loop gain, 0.546 [0.456,0.717] in NREM vs 0.365 [0.238,0.459] in REM sleep; P = .0026). Patients with REM displayed a significantly more collapsible airway (ie, lower Vpassive) in REM compared with NREM sleep (98.4 [97.3,99.2] %Veupnea in NREM vs 95.9 [86.4,98.9] %Veupnea in REM sleep; P < .0001). The major between-group difference across the whole night was a significantly higher loop gain in the NREM group (0.561 [0.429,0.675]) compared with the REM group (0.459 [0.388,0.539]; P = .0033).
This study is the first to link long-recognized polysomnographic patterns of OSA to underlying physiologic differences. Patients with NREM have a higher loop gain in NREM sleep; patients with REM have a worsening of Vpassive in REM sleep.
阻塞性睡眠呼吸暂停（OSA）患者的大多数呼吸事件可能发生在快速眼动（REM）睡眠期或非快速眼动（NREM）睡眠期。此前尚无研究将REM睡眠和NREM睡眠中的不同生理状态与日常临床实践中常见的多导睡眠图模式联系起来，即REM为主型OSA（REM）和NREM为主型OSA（NREM）。
（1）NREM和REM患者中，OSA的生理状态如何随睡眠阶段变化？（2）NREM和REM患者是否存在不同的潜在OSA病理生理状态？
我们招募了具有三种多导睡眠图模式的患者。（1）REM型：REM睡眠期呼吸事件数量是其他睡眠期的两倍；（2）NREM型：NREM睡眠期呼吸事件数量是其他睡眠期的两倍；（3）均匀型OSA：NREM/REM睡眠期呼吸事件数量相等。我们采用一种非侵入性表型分析方法来确定每组患者（NREM型、REM型、均匀型OSA）在NREM睡眠期、REM睡眠期及全夜睡眠中的OSA内型特征（被动通气量、主动通气量、环路增益、唤醒阈值）。
与REM睡眠相比，NREM型患者在NREM睡眠期的通气控制稳定性明显更差（环路增益，NREM睡眠期为0.546[0.456,0.717]，REM睡眠期为0.365[0.238,0.459]；P = 0.0026）。与NREM睡眠相比，REM型患者在REM睡眠期的气道塌陷程度明显更高（即被动通气量更低）（NREM睡眠期为正常通气量的98.4[97.3,99.2]%，REM睡眠期为正常通气量的95.9[86.4,98.9]%；P < 0.0001）。全夜期间，组间的主要差异是NREM组的环路增益（0.561[0.4,29,0.675]）显著高于REM组（0.459[0.388,0.539]；P = 0.0033）。
本研究首次将长期公认的OSA多导睡眠图模式与潜在的生理差异联系起来。NREM型患者在NREM睡眠期的环路增益更高；REM型患者在REM睡眠期的被动通气量更差。
