Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Sleep. 2022 Sep 8;45(9). doi: 10.1093/sleep/zsac129.
Obstructive sleep apnea (OSA) is characterized by multiple "endotypic traits," including pharyngeal collapsibility, muscle compensation, loop gain, and arousal threshold. Here, we examined (1) within-night repeatability, (2) long-term consistency, and (3) influences of body position and sleep state, of endotypic traits estimated from in-home polysomnography in mild-to-severe OSA (apnea-hypopnea index, AHI > 5 events/h).
Within-night repeatability was assessed using Multi-Ethnic Study of Atherosclerosis (MESA): Traits derived separately from "odd" and "even" 30-min periods were correlated and regression (error vs. N windows available) provided a recommended amount of data for acceptable repeatability (Rthreshold = 0.7). Long-term consistency was assessed using the Osteoporotic Fractures in Men Study (MrOS) at two time points 6.5 ± 0.7 years apart, before and after accounting for across-year body position and sleep state differences. Within-night dependence of traits on position and state (MESA plus MrOS data) was estimated using bootstrapping.
Within-night repeatability for traits ranged from R = 0.62-0.79 and improved to R = 0.69-0.83 when recommended amounts of data were available (20-35 7-min windows, available in 94%-98% of participants); repeatability was similar for collapsibility, loop gain, and arousal threshold (R = 0.79-0.83), but lower for compensation (R = 0.69). Long-term consistency was modest (R = 0.30-0.61) and improved (R = 0.36-0.63) after accounting for position and state differences. Position/state analysis revealed reduced loop gain in REM and reduced collapsibility in N3.
Endotypic traits can be obtained with acceptable repeatability. Long-term consistency was modest but improved after accounting for position and state changes. These data support the use of endotypic assessments in large-scale epidemiological studies.
The data used in the manuscript are from observational cohort studies and are not a part of the clinical trial.
阻塞性睡眠呼吸暂停（OSA）的特征是多种“表型特征”，包括咽腔塌陷、肌肉代偿、环路增益和觉醒阈值。在这里，我们检查了（1）夜间内的可重复性，（2）长期一致性，以及（3）体位和睡眠状态的影响，这些特征是通过在家中进行多导睡眠图（PSG）评估得出的，涉及轻至重度 OSA（呼吸暂停-低通气指数，AHI > 5 次/小时）。
夜间内的可重复性使用多民族动脉粥样硬化研究（MESA）进行评估：分别从“奇数”和“偶数”30 分钟期间得出的特征进行相关，回归（误差与可用的 N 窗口）提供了可接受的可重复性的推荐数据量（Rthreshold = 0.7）。长期一致性使用骨质疏松症男性研究（MrOS）进行评估，两次时间点相隔 6.5 ± 0.7 年，在考虑跨年度体位和睡眠状态差异之前和之后进行。特征在体位和状态上的夜间内依赖性（MESA 和 MrOS 数据）使用自举法进行估计。
特征的夜间内可重复性范围从 R = 0.62-0.79 提高到 R = 0.69-0.83，当可用的推荐数据量（94%-98%的参与者中可用的 20-35 个 7 分钟窗口）增加时；塌陷、环路增益和觉醒阈值的可重复性相似（R = 0.79-0.83），但代偿的可重复性较低（R = 0.69）。长期一致性中等（R = 0.30-0.61），在考虑体位和状态差异后有所提高（R = 0.36-0.63）。体位/状态分析显示 REM 中的环路增益降低，N3 中的塌陷减少。
表型特征可以具有可接受的可重复性。长期一致性中等，但在考虑体位和状态变化后有所提高。这些数据支持在大规模的流行病学研究中使用表型评估。
本文使用的数据来自观察性队列研究，不属于临床试验的一部分。
