Li Hong Peng, Wang Hai Qin, Li Ning, Zhang Liu, Li Shi Qi, Yan Ya Ru, Lu Huan Huan, Wang Yi, Sun Xian Wen, Lin Ying Ni, Zhou Jian Ping, Li Qing Yun
Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
Nat Sci Sleep. 2021 Apr 21;13:493-501. doi: 10.2147/NSS.S299646. eCollection 2021.
The carotid body (CB) is a major peripheral respiratory chemoreceptor. In patients with obstructive sleep apnea (OSA), high CB chemosensitivity (CBC) is associated with refractory hypertension and insulin resistance and known to further aggravate OSA. Thus, the identification of high CB (hCBC) among OSA patients is of clinical significance, but detection methods are still limited. Therefore, this study aimed to explore the association of CBC with OSA severity and to develop a simplified model that can identify patients with hCBC.
In this cross-sectional study of subjects who underwent polysomnography (PSG), CBC was measured using the Dejours test. We defined hCBC as a decrease of >12% in respiratory rate (RR) after breathing of pure O. The association of CBC with OSA severity was explored by logistic regression, and a model for identifying hCBC was constructed and confirmed using receiver operating characteristic analysis.
Patients with OSA (n=142) and individuals without OSA (n=38) were enrolled. CBC was higher in patients with OSA than in those without OSA (% decrease in RR, 15.2%±13.3% vs 9.1%±7.5%, P<0.05). Apnea-hypopnea index (AHI), fraction of apnea-hypopnea events in rapid-eye-movement sleep (F), and longest time of apnea (LTA) were associated with hCBC independently (odds ratio [OR]=1.048, OR=1.082, and OR=1.024 respectively; all <0.05). The model for identifying hCBC allocated a score to each criterion according to its OR values, ie, 1 (LTA >48.4 s), 2 (AHI >15.7 events/hour), and 3 (F >12.7%). A score of 3 or greater indicated hCBC with a sensitivity of 79.4% and specificity of 88.2%.
High CBC is associated with the severity of OSA. A simplified scoring system based on clinical variables from PSG can be used to identify hCBC.
颈动脉体（CB）是主要的外周呼吸化学感受器。在阻塞性睡眠呼吸暂停（OSA）患者中，高颈动脉体化学敏感性（CBC）与难治性高血压和胰岛素抵抗相关，且已知会进一步加重OSA。因此，在OSA患者中识别高颈动脉体（hCBC）具有临床意义，但检测方法仍然有限。因此，本研究旨在探讨CBC与OSA严重程度的关联，并建立一个能够识别hCBC患者的简化模型。
在这项对接受多导睡眠图（PSG）检查的受试者进行的横断面研究中，使用德茹尔测试测量CBC。我们将hCBC定义为吸入纯氧后呼吸频率（RR）下降>12%。通过逻辑回归探讨CBC与OSA严重程度的关联，并使用受试者工作特征分析构建并验证一个识别hCBC的模型。
纳入了OSA患者（n = 142）和非OSA个体（n = 38）。OSA患者的CBC高于非OSA患者（RR下降百分比，15.2%±13.3%对9.1%±7.5%，P<0.05）。呼吸暂停低通气指数（AHI）、快速眼动睡眠期呼吸暂停低通气事件比例（F）和最长呼吸暂停时间（LTA）分别独立与hCBC相关（比值比[OR]=1.048、OR = 1.082和OR = 1.024；均<0.05）。识别hCBC的模型根据其OR值为每个标准分配一个分数，即1分（LTA>48.4秒）、2分（AHI>15.7次/小时）和3分（F>12.7%）。3分或更高分数表明为hCBC，敏感性为79.4%，特异性为88.2%。
高CBC与OSA的严重程度相关。基于PSG临床变量的简化评分系统可用于识别hCBC。
