Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Yeni Mahalle Şehit Astsubay Mustafa Soner Varlık Caddesi No:77, PK:10200, Bandirma / Balikesir, Turkey.
Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
Sleep Breath. 2021 Dec;25(4):1961-1967. doi: 10.1007/s11325-021-02322-2. Epub 2021 Feb 20.
Nocturnal hypoxia and daytime sleepiness resulting from fragmented sleep may impair the ability of postural stability in subjects with OSA. This study investigates the effect of disease severity on postural stability and whether or not it poses a fall risk in individuals with obstructive sleep apnea (OSA).
Forty-nine patients with OSA diagnosed by all-night polysomnography (apnea-hypopnea index (AHI) ≥ 5) and aged 51.4 ± 7.2 years were included in the study. The patients were divided into two groups as severe OSA (AHI ≥ 30, n = 24) and non-severe OSA (5 ≤ AHI ≤ 30, n = 25). All patients were subjected to testing for postural stability (PS), limits of stability (LOST), and the stability index for fall risk (fall risk SI) with the Biodex Balance System®. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Biodex measurements and daytime sleepiness were compared between severe and non-severe OSA groups. Univariate analysis was conducted to explore if AHI, ESS score, lowest SaO (%), sleep stages (%), or total arousal index predict postural stability scores.
Overall and anterior-posterior PS indices were higher in the severe OSA group (p < 0.05). Dynamic PS and fall risk indices did not differ between groups. AHI and lowest SaO (%) were found to be an independent predictor for both overall PS (r = 0.300 and r = 0.286, respectively) and fall risk SI (r = 0.296 and r = 0.374, respectively), whereas stage N1 (%) and stage N3 (%) were an independent predictor for overall LOST score (r = -0.328 and r = 0.298, respectively) (p < 0.05).
Static postural stability of individuals with severe OSA is worse than those with non-severe OSA. Static postural stability worsens, and fall risk increases as AHI increases and the lowest SaO decreases in individuals with OSA. On the other hand, dynamic postural stability worsens as stage N1 (%) sleep increases and stage N3 (%) sleep decreases. While nocturnal hypoxia indicators such as AHI and lowest SaO are associated with static postural stability, sleep structure-related variables are associated with dynamic stability. Including postural stability assessments in the clinical practice for OSA may help addressing workplace accidents or tendency to fall.
www.ClinicalTrials.gov registration number: NCT03589417.
由睡眠片段化引起的夜间低氧和日间嗜睡可能会损害阻塞性睡眠呼吸暂停（OSA）患者的姿势稳定性。本研究旨在探讨疾病严重程度对姿势稳定性的影响，以及是否会增加阻塞性睡眠呼吸暂停患者的跌倒风险。
本研究共纳入 49 名经整夜多导睡眠图（呼吸暂停低通气指数（AHI）≥5）诊断为 OSA 的患者，年龄为 51.4±7.2 岁。患者分为两组：重度 OSA（AHI≥30，n=24）和非重度 OSA（5≤AHI≤30，n=25）。所有患者均接受姿势稳定性（PS）、稳定性极限（LOST）和跌倒风险稳定性指数（跌倒风险 SI）的 Biodex 平衡系统®测试。日间嗜睡采用 Epworth 嗜睡量表（ESS）评估。比较重度和非重度 OSA 组之间的 Biodex 测量值和日间嗜睡情况。采用单因素分析探讨 AHI、ESS 评分、最低 SaO（%）、睡眠阶段（%）或总唤醒指数是否能预测姿势稳定性评分。
重度 OSA 组的总体和前后向 PS 指数较高（p<0.05）。两组间动态 PS 和跌倒风险指数无差异。AHI 和最低 SaO（%）是总体 PS（r=0.300 和 r=0.286）和跌倒风险 SI（r=0.296 和 r=0.374）的独立预测因子，而 N1 期（%）和 N3 期（%）是总体 LOST 评分的独立预测因子（r=-0.328 和 r=0.298）（p<0.05）。
与非重度 OSA 患者相比，重度 OSA 患者的静态姿势稳定性更差。随着 OSA 患者 AHI 增加和最低 SaO 降低，静态姿势稳定性恶化，跌倒风险增加。另一方面，随着 N1 期（%）睡眠增加和 N3 期（%）睡眠减少，动态姿势稳定性恶化。虽然 AHI 和最低 SaO 等夜间低氧指标与静态姿势稳定性相关，但与睡眠结构相关的变量与动态稳定性相关。在 OSA 的临床实践中加入姿势稳定性评估可能有助于减少工作场所事故或跌倒倾向。
www.ClinicalTrials.gov 注册号：NCT03589417。
