Bahr Katharina, Geisler Vincent, Huppertz Tilman, Groppa Sergiu, Matthias Christoph, Gouveris Haralampos, Muthuraman Muthuraman
Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the University of Mainz, 55131 Mainz, Germany.
Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Medical Center of the University of Mainz, 55131 Mainz, Germany.
Brain Sci. 2021 Feb 25;11(3):282. doi: 10.3390/brainsci11030282.
We investigated whether the number, duration and intensity of respiratory arousals (RA) on C3-electroencephalographic (EEG) recordings correlate with polysomnography (PSG)-related disease severity in obstructive sleep apnea (OSA) patients. We also investigated if every patient might have an individual RA microstructure pattern, independent from OSA-severity.
PSG recordings of 20 OSA patients (9 female; age 27-80 years) were analyzed retrospectively. Correlation coefficients were calculated between RA microstructure (duration, EEG-intensity) and RA number and respiratory disturbance index (RDI), oxygen desaturation index (ODI) and arousal index (AI). Intraclass correlations (ICC) for both RA duration and intensity were calculated. Sleep stage-specific and apnea- and hypopnea-specific analyses were also done. The probability distributions of duration and intensity were plotted, interpolated with a kernel which fits the distribution. A Bayesian posterior distribution analysis and pair-wise comparisons of each patient with all other 19 patients were performed.
Of the analyzed 2600 RA, strong positive correlations were found between average RA intensity and both RDI and AI. The number of PSG-recorded RA was strongly positively correlated with RDI. Significant correlations between average RA intensity in REM, NREM2 and NREM3 sleep stages and total ODI were identified. No sleep stage-specific correlations of arousal microstructure with age, sex, RDI or AI were identified. Although between-subjects ICC values were <0.25, within-subject ICC values were all >0.7 (all < 0.05). While apnea-related RA duration did not differ from hypopnea-related RA duration, RA intensity was significantly higher ( = 0.00135) in hypopneas than in apneas. A clear individual pattern of arousal duration for each patient was made distinct. For arousal intensity, a Gaussian distribution was identified in most patients. The Bayesian statistics regarding the arousal microstructure showed significant differences between each pair of patients.
Each individual patient with OSA might have an individual pattern of RA intensity and duration indicating a distinct individual pathophysiological feature. Arousal intensity was significantly higher in hypopneic than in apneic events and may be related causally to the diminished (compared to apneas) respiratory distress associated with hypopneas. RA intensity in REM, NREM2 and NREM3 strongly correlated with ODI.
我们研究了C3脑电图（EEG）记录中呼吸觉醒（RA）的次数、持续时间和强度是否与阻塞性睡眠呼吸暂停（OSA）患者的多导睡眠图（PSG）相关疾病严重程度相关。我们还研究了每位患者是否可能有独立于OSA严重程度的个体RA微观结构模式。
对20例OSA患者（9例女性；年龄27 - 80岁）的PSG记录进行回顾性分析。计算RA微观结构（持续时间、EEG强度）与RA次数、呼吸紊乱指数（RDI）、氧饱和度下降指数（ODI）和觉醒指数（AI）之间的相关系数。计算RA持续时间和强度的组内相关系数（ICC）。还进行了睡眠阶段特异性以及呼吸暂停和低通气特异性分析。绘制持续时间和强度的概率分布，用拟合该分布的核进行插值。对每位患者与其他19位患者进行贝叶斯后验分布分析和成对比较。
在分析的2600次RA中，发现平均RA强度与RDI和AI均呈强正相关。PSG记录的RA次数与RDI呈强正相关。确定了快速眼动（REM）、非快速眼动2（NREM2）和非快速眼动3（NREM3）睡眠阶段的平均RA强度与总ODI之间存在显著相关性。未发现觉醒微观结构与年龄、性别、RDI或AI的睡眠阶段特异性相关性。虽然受试者间ICC值<0.25，但受试者内ICC值均>0.7（均<0.05）。虽然与呼吸暂停相关的RA持续时间与与低通气相关的RA持续时间无差异，但低通气时的RA强度显著高于呼吸暂停时（=0.00135）。为每位患者明确了清晰的觉醒持续时间个体模式。对于觉醒强度，大多数患者呈现高斯分布。关于觉醒微观结构的贝叶斯统计显示每位患者之间存在显著差异。
每位OSA个体患者可能具有RA强度和持续时间的个体模式，表明独特的个体病理生理特征。低通气事件中的觉醒强度显著高于呼吸暂停事件，并且可能与低通气相关的（与呼吸暂停相比）呼吸窘迫减轻存在因果关系。REM、NREM2和NREM3中的RA强度与ODI密切相关。
