School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Sleep Med. 2021 Aug;84:253-258. doi: 10.1016/j.sleep.2021.06.001. Epub 2021 Jun 9.
Prior studies have identified symptom subtypes of moderate to severe (AHI >15) obstructive sleep apnea (OSA). They have not yet been consistently examined in those with mild OSA (AHI 5-15 events/hour). This is important as women are more likely than men to present with mild OSA and may present with different OSA symptoms. The objectives of this study were to determine 1) symptom subtypes in mild OSA and 2) if there are sex differences in the distribution of subtypes.
The sample included men (n = 921) and women (n = 797) with mild OSA, aged 39-90 years, evaluated with a single night of in-home polysomnography as part of the Sleep Heart Health Study. Latent class analysis determined symptom subtypes. Testing for sex differences relative to OSA severity and symptom subtype used chi-squared test for independence. Bonferroni corrected z-tests compared column proportions.
Symptom subtypes of mild OSA were not significantly different than those identified in prior studies of moderate-severe OSA (p > 0.05): minimally symptomatic (36.4%), disturbed sleep (11.6%), moderately sleepy (37%), and excessively sleepy (15%), p > 0.05. Sex differences within the symptom subtypes were significant [χ(df = 3) = 30.04, p < 0.001, Cramer's V = 0.132]. Relative to men, women were more likely to be in the disturbed sleep subtype (p < 0.05), and the excessively sleepy subtype (p < 0.05) while less likely to be in the moderately sleep (<0.05) subtype. Women and men were equally represented in the minimal symptoms subtype (p > 0.05).
Results suggest symptom reporting among individuals with mild OSA differs as a function of sex. These data have important clinical implications for screening men and women for OSA.
先前的研究已经确定了中重度（AHI>15）阻塞性睡眠呼吸暂停（OSA）的症状亚型。但这些研究尚未在轻度 OSA（AHI 为 5-15 次/小时）患者中得到一致的检查。这一点很重要，因为女性比男性更容易出现轻度 OSA，并且可能会出现不同的 OSA 症状。本研究的目的是确定 1）轻度 OSA 的症状亚型，以及 2）在亚型分布方面是否存在性别差异。
该样本包括 921 名男性和 797 名年龄在 39-90 岁之间的轻度 OSA 患者，他们在睡眠中心接受了一晚上的家庭多导睡眠图检查，这是睡眠心脏健康研究的一部分。潜在类别分析确定了症状亚型。使用卡方检验进行独立性检验，以测试性别差异与 OSA 严重程度和症状亚型的关系。Bonferroni 校正后的 z 检验比较了列比例。
轻度 OSA 的症状亚型与先前中重度 OSA 研究中确定的症状亚型没有显著差异（p>0.05）：轻度症状（36.4%）、睡眠障碍（11.6%）、中度嗜睡（37%）和极度嗜睡（15%），p>0.05。在症状亚型内，性别差异显著[χ(df=3)=30.04，p<0.001，Cramer's V=0.132]。与男性相比，女性更有可能属于睡眠障碍亚型（p<0.05），而属于极度嗜睡亚型的可能性较小（p<0.05），而属于中度嗜睡亚型的可能性较小（p<0.05）。女性和男性在轻度症状亚型中的比例相当（p>0.05）。
结果表明，轻度 OSA 患者的症状报告因性别而异。这些数据对筛查男性和女性的 OSA 具有重要的临床意义。
