Liu Xiaodi, Lam David Chi-Leung, Mak Henry Ka-Fung, Ip Mary Sau-Man, Lau Kui Kai
Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Front Neurol. 2022 Aug 25;13:956208. doi: 10.3389/fneur.2022.956208. eCollection 2022.
Obstructive sleep apnea (OSA) is associated with cerebral small vessel disease (CSVD). Nonetheless, whether OSA-risk determined by a simple screening questionnaire or indices quantifying nocturnal hypoxemia other than the conventional apnea-hypopnea index (AHI) by the home sleep apnea test (HSAT) associated with CSVD burden remains uncertain.
From 2018 to 2021, we recruited patients with transient ischemic attack (TIA)/minor stroke from the Queen Mary Hospital Acute Stroke Unit and TIA/Stroke Outpatient Clinics. Logistic regression models were applied to determine the association of baseline OSA-risk (on STOP-BANG questionnaire) or HSAT-derived indices quantifying nocturnal hypoxemia with global burden/individual markers of CSVD on MRI. Indices included oxygen desaturation (≥3%) index (ODI), minimum oxygen saturation (SpO), percentage of total sleep time with an oxygen saturation <90% (CT90%), and desaturation duration (≥3%, DesDur).
In 283 patients with TIA/minor stroke (mean age 65 years, 64% men), OSA-risk was significantly associated with total CSVD score (multivariate-adjusted odds ratio: 1.23, 95% confidence interval 1.01-1.51), presence of lacunes [1.39 (1.09-1.79)] and burden of basal ganglia PVSs [1.32 (1.06-1.67)]. In 85/283 patients who completed HSAT, neither AHI, minimum SpO nor CT90% was associated with CSVD burden. Nonetheless, ODI and DesDur remained significantly associated with total CSVD score after covariate adjustment: ODI [1.04 (1.01-1.07)] and DesDur [1.04 (1.01-1.08)].
In patients with TIA/minor stroke, high OSA-risk was associated with a greater CSVD burden. Oxygen desaturation indices (ODI and DesDur) rather than AHI were independently associated with global CSVD burden, indicating that longer and more severe desaturations may contribute to the pathogenesis of CSVD.
阻塞性睡眠呼吸暂停（OSA）与脑小血管疾病（CSVD）相关。然而，通过简单筛查问卷确定的OSA风险或通过家庭睡眠呼吸暂停测试（HSAT）得出的除传统呼吸暂停低通气指数（AHI）之外的夜间低氧血症量化指标是否与CSVD负担相关仍不确定。
2018年至2021年，我们从玛丽医院急性卒中单元和短暂性脑缺血发作/卒中门诊招募了短暂性脑缺血发作（TIA）/轻度卒中患者。应用逻辑回归模型确定基线OSA风险（基于STOP-BANG问卷）或HSAT得出的夜间低氧血症量化指标与MRI上CSVD的总体负担/个体标志物之间的关联。指标包括氧饱和度下降（≥3%）指数（ODI）、最低氧饱和度（SpO）、氧饱和度<90%的总睡眠时间百分比（CT90%）以及饱和度下降持续时间（≥3%，DesDur）。
在283例TIA/轻度卒中患者（平均年龄65岁，64%为男性）中，OSA风险与CSVD总分显著相关（多变量调整优势比：1.23，95%置信区间1.01 - 1.51），腔隙性梗死的存在[1.39（1.09 - 1.79）]以及基底节区脑白质疏松症的负担[1.32（1.06 - 1.67）]。在完成HSAT的85/283例患者中，AHI、最低SpO和CT90%均与CSVD负担无关。然而，在协变量调整后，ODI和DesDur仍与CSVD总分显著相关：ODI[1.04（1.01 - 1.07）]和DesDur[1.04（1.01 - 1.08）]。
在TIA/轻度卒中患者中，高OSA风险与更大的CSVD负担相关。氧饱和度下降指标（ODI和DesDur）而非AHI与CSVD总体负担独立相关，表明更长时间和更严重的饱和度下降可能在CSVD的发病机制中起作用。
