Sata Naoko, Inoshita Ayako, Suda Shoko, Shiota Satomi, Shiroshita Nanako, Kawana Fusae, Suzuki Yo, Matsumoto Fumihiko, Ikeda Katsuhisa, Kasai Takatoshi
Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan.
Sleep Breath. 2021 Sep;25(3):1379-1387. doi: 10.1007/s11325-020-02241-8. Epub 2020 Nov 17.
Obstructive sleep apnea (OSA) is induced by a sleep-related collapse of the upper airway in association with multiple factors. The severity of OSA is determined by the apnea-hypopnea index (AHI). Although obesity and sex differences are common factors in OSA, the level of the AHI varies to the same degree according to the age and sex and degree of obesity. However, only a few studies have evaluated AHI over 100/h, those reports did not describe why they set the AHI cutoff at 100/h. The purpose of this study was to elucidate the pathogenesis of "very" severe OSA, defined as having an AHI > 100/h.
AHI > 100/h was set as very severe OSA (VS-OSA) in this study. As controls, moderate to severe OSA patients, matched with VS-OSA for age, sex, and body mass index (BMI), were enrolled. The findings of polysomnography and cephalography between VS-OSA and controls were compared.
Eleven patients in the VS-OSA group (mean AHI 110.2/h) and 22 patients in the control group (mean AHI 41.6/h) were compared (mean age 50.2 vs 50.6, male:female 5:6 vs 10:12, mean BMI 35.4 kg/m vs 34.5 kg/m). There were no significant differences in the clinical characteristics. In the polysomnographic parameters, the VS-OSA group showed apnea predominance, the mean percutaneous oxygen saturation (SO) was significantly lower in all sleep stages, and the minimum SO was significantly lower (49.0% vs 77.5%, p = 0.002). A similar apnea duration and rather shorter hypopnea duration were shown. The time of apnea-to-arousal was significantly earlier (- 0.1 s vs 0.9 s, p = 0.003). Lung-to-finger circulation time showed no differences. The cephalometric findings showed no significant differences.
VS-OSA patients were more likely to have apnea predominance, desaturation when sleeping despite a similar apnea duration, and rather shorter hypopnea duration, and arousals were evoked significantly earlier.
阻塞性睡眠呼吸暂停（OSA）是由上气道睡眠相关塌陷并伴有多种因素引起的。OSA的严重程度由呼吸暂停低通气指数（AHI）决定。虽然肥胖和性别差异是OSA的常见因素，但AHI水平根据年龄、性别和肥胖程度的变化程度相同。然而，只有少数研究评估了AHI超过100次/小时的情况，那些报告并未描述为何将AHI临界值设定为100次/小时。本研究的目的是阐明定义为AHI>100次/小时的“极”重度OSA的发病机制。
本研究将AHI>100次/小时设定为极重度OSA（VS-OSA）。作为对照，纳入了年龄、性别和体重指数（BMI）与VS-OSA相匹配的中重度OSA患者。比较了VS-OSA组和对照组之间的多导睡眠图和头颅测量结果。
比较了VS-OSA组的11例患者（平均AHI为110.2次/小时）和对照组的22例患者（平均AHI为41.6次/小时）（平均年龄50.2岁对50.6岁，男性:女性5:6对10:12，平均BMI 35.4kg/m对34.5kg/m）。临床特征无显著差异。在多导睡眠图参数方面，VS-OSA组以呼吸暂停为主，所有睡眠阶段的平均经皮血氧饱和度（SO）显著较低，最低SO显著更低（49.0%对77.5%，p = 0.002）。呼吸暂停持续时间相似，低通气持续时间较短。呼吸暂停至觉醒的时间显著更早（-0.1秒对0.9秒，p = 0.003）。肺至手指循环时间无差异。头颅测量结果无显著差异。
VS-OSA患者更易出现呼吸暂停为主、睡眠时出现低氧血症（尽管呼吸暂停持续时间相似）、低通气持续时间较短，且觉醒显著更早。
