Gnoni Valentina, Drakatos Panagis, Higgins Sean, Duncan Iain, Wasserman Danielle, Kabiljo Renata, Mutti Carlotta, Halasz Peter, Goadsby Peter J, Leschziner Guy D, Rosenzweig Ivana
Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.
Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK.
J Sleep Res. 2021 Dec;30(6):e13350. doi: 10.1111/jsr.13350. Epub 2021 May 3.
Obstructive sleep apnea is linked to cardiovascular disease, metabolic disorders and dementia. The precise nature of the association between respiratory events in obstructive sleep apnea, cortical or subcortical arousals, and cognitive, autonomic and oxidative stress consequences remains incompletely elucidated. Previous studies have aimed to understand the relationship between obstructive sleep apnea and arousal patterns, as defined by the cyclic alternating pattern, but results have been inconsistent, in part likely due to the presence of associated comorbidities. To better define this relationship, we analysed cyclic alternating patterns in patients with obstructive sleep apnea without any additional comorbidities. We identified 18 adult male, non-obese subjects with obstructive sleep apnea and no other comorbidities or medication history, who underwent whole-night electroencephalography and polysomnography. Cyclic alternating pattern analysis was performed and verified by certified somnologists. Pairwise linear regression analysis demonstrated an inverse relationship between obstructive sleep apnea severity and cyclic alternating pattern subtype A1, and a direct correlation with cyclic alternating pattern subtype A3. Cyclic alternating pattern subtypes A1 prevail in milder obstructive sleep apnea phenotype, whilst cyclic alternating pattern subtypes A2 and A3 overcome among moderate-to-severe obstructive sleep apnea patients. The milder obstructive sleep apnea group also presented higher sleep efficiency, and increased percentages of non-rapid eye movement stage 3 and rapid eye movement sleep, as well as longer cyclic alternating pattern sequences in N3, while severe obstructive sleep apnea patients spent more time in lighter sleep stages. These results imply/suggest a balance between cyclic alternating pattern's adaptive and maladaptive arousal processes in obstructive sleep apnea of differing severities. In milder obstructive sleep apnea (apnea-hypopnea index < 20), sleep continuity may be reinforced by cyclic alternating pattern subtype A1, whereas in more severe obstructive sleep apnea, decompensation of these sleep-stabilizing mechanisms may occur and more intrusive cyclic alternating pattern fluctuations disrupt sleep circuitry.
阻塞性睡眠呼吸暂停与心血管疾病、代谢紊乱和痴呆症有关。阻塞性睡眠呼吸暂停中的呼吸事件、皮质或皮质下觉醒与认知、自主神经和氧化应激后果之间关联的确切性质仍未完全阐明。以往的研究旨在了解阻塞性睡眠呼吸暂停与由周期性交替模式定义的觉醒模式之间的关系，但结果并不一致，部分原因可能是存在相关的合并症。为了更好地定义这种关系，我们分析了无任何其他合并症的阻塞性睡眠呼吸暂停患者的周期性交替模式。我们纳入了18名成年男性非肥胖阻塞性睡眠呼吸暂停患者，他们无其他合并症或用药史，接受了整夜脑电图和多导睡眠图检查。周期性交替模式分析由认证的睡眠专家进行并验证。成对线性回归分析表明，阻塞性睡眠呼吸暂停严重程度与周期性交替模式A1亚型呈负相关，与周期性交替模式A3亚型呈正相关。周期性交替模式A1亚型在较轻的阻塞性睡眠呼吸暂停表型中占主导，而周期性交替模式A2和A3亚型在中重度阻塞性睡眠呼吸暂停患者中占优势。较轻的阻塞性睡眠呼吸暂停组还表现出更高的睡眠效率、非快速眼动睡眠3期和快速眼动睡眠百分比增加，以及N3期更长的周期性交替模式序列，而重度阻塞性睡眠呼吸暂停患者在较浅睡眠阶段花费的时间更多。这些结果表明，在不同严重程度的阻塞性睡眠呼吸暂停中，周期性交替模式的适应性和适应不良性觉醒过程之间存在平衡。在较轻的阻塞性睡眠呼吸暂停（呼吸暂停低通气指数<20）中，周期性交替模式A1亚型可能会加强睡眠连续性，而在更严重的阻塞性睡眠呼吸暂停中，这些睡眠稳定机制可能会失代偿，更具侵入性的周期性交替模式波动会扰乱睡眠回路。
