Sowho Mudiaga, Potocki Mariah, Sgambati Frank, Neptune Enid
Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA.
Center for Interdisciplinary Sleep Research and Education, Johns Hopkins School of Medicine, Baltimore, MD USA.
Sleep Biol Rhythms. 2023;21(1):33-37. doi: 10.1007/s41105-022-00413-5. Epub 2022 Aug 11.
Recent reports suggest that self-reported snoring, which is a feature of obstructive sleep apnea, is associated with aortic enlargement in Marfan syndrome (MFS). Objective assessment of snoring although lacking, could provide a rational for OSA screening in MFS patients. Our goal in this study was to examine the association between objective measurements of snoring with OSA and aortic size in persons with MFS. Consecutive persons with MFS who reported snoring were recruited at Johns Hopkins, completed the Epworth Sleepiness Scale (ESS) and underwent overnight polysomnography during which inspiratory sound was captured. We measured breath-by-breath peak decibel levels and snoring was defined as flow limitation with sound ≥ 40 dB(A). OSA was defined as an apnea-hypopnea-index (AHI) ≥ 15 or AHI: 5-15 and ESS > 10. Participants' aortic data were collated to ascertain aortic root diameter. Regression models were used to determine the relationship of snoring breath% with OSA and aortic root diameter. In our cohort (M|F:13|16, Age: 37.0 ± 15.5 years, Aortic diameter; 38.9 ± 4.8 mm), a 1-unit increase in snoring breath percentage increased the odds of having OSA by 5% in both the unadjusted (OR = 1.05, = 0.040) model, and a model adjusted for age and sex (OR = 1.05, = 0.048). Similarly, a 10-unit increase in snoring breath percentage was associated with a 1 mm increase in contemporaneous aortic-root-diameter in both unadjusted ( = 0.09, = 0.007), and adjusted ( = 0.08, = 0.023) models. Objective snoring assessment could provide a means for identifying persons with MFS who need sleep studies, who may also be at risk for more severe aortic disease.
最近的报告表明，自我报告的打鼾是阻塞性睡眠呼吸暂停的一个特征，与马凡综合征（MFS）的主动脉扩张有关。尽管缺乏对打鼾的客观评估，但可为MFS患者的阻塞性睡眠呼吸暂停（OSA）筛查提供依据。我们在本研究中的目标是检查MFS患者打鼾的客观测量值与OSA和主动脉大小之间的关联。在约翰·霍普金斯医院招募了连续的报告打鼾的MFS患者，完成爱泼华嗜睡量表（ESS），并在夜间进行多导睡眠监测，在此期间采集吸气声音。我们逐次测量呼吸峰值分贝水平，打鼾定义为声音≥40 dB(A)的气流受限。OSA定义为呼吸暂停低通气指数（AHI）≥15或AHI：5 - 15且ESS>10。整理参与者的主动脉数据以确定主动脉根部直径。使用回归模型确定打鼾呼吸百分比与OSA和主动脉根部直径的关系。在我们的队列中（男/女：13/16，年龄：37.0±15.5岁，主动脉直径；38.9±4.8毫米），在未调整模型（OR = 1.05，P = 0.040）和调整了年龄和性别的模型（OR = 1.05，P = 0.048）中，打鼾呼吸百分比每增加1个单位，患OSA的几率增加5%。同样，在未调整模型（P = 0.09，P = 0.007）和调整模型（P = 0.08，P = 0.023）中，打鼾呼吸百分比增加10个单位与同期主动脉根部直径增加1毫米相关。客观的打鼾评估可为识别需要进行睡眠研究的MFS患者提供一种方法，这些患者可能也有患更严重主动脉疾病的风险。
