Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA.
Sleep. 2023 Aug 14;46(8). doi: 10.1093/sleep/zsad058.
Phenotyping using polysomnography (PUP) is an algorithmic method to quantify physiologic mechanisms underlying obstructive sleep apnea (OSA): loop gain (LG1), arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and muscular compensation (Vcomp). The consecutive-night test-retest reliability and agreement of PUP-derived estimates are unknown. From a cohort of elderly (age ≥55 years), largely non-sleepy, community-dwelling volunteers who underwent in-lab polysomnography (PSG) on 2 consecutive nights, we determined the test-retest reliability and agreement of PUP-estimated physiologic factors.
Participants who had an apnea-hypopnea index (AHI3A) of at least 15 events per hour on the first night were included. PUP analyses were performed on each of the two PSGs from each participant. Physiologic factor estimates were derived from NREM sleep and compared across nights using intraclass correlation coefficients for reliability and smallest real differences (SRD) for agreement.
Two PSGs from each of 43 participants (86 total) were analyzed. A first-night effect was evident with increased sleep time and stability and decreased OSA severity on the second night. LG1, ArTH, and Vpassive demonstrated good reliability (ICC > 0.80). Vcomp had modest reliability (ICC = 0.67). For all physiologic factors, SRD values were approximately 20% or more of the observed ranges, suggesting limited agreement of longitudinal measurements for a given individual.
For NREM sleep in cognitively normal elderly individuals with OSA, PUP-estimated LG1, ArTH, and Vpassive demonstrated consistent relative ranking of individuals (good reliability) on short-term repeat measurement. For all physiologic factors, longitudinal measurements demonstrated substantial intraindividual variability across nights (limited agreement).
使用多导睡眠图（PUP）进行表型分析是一种量化阻塞性睡眠呼吸暂停（OSA）下生理机制的算法方法：环路增益（LG1）、觉醒阈值（ArTH）、上气道顺应性（Vpassive）和肌肉补偿（Vcomp）。目前尚不清楚 PUP 衍生估计值的连续夜间测试 - 再测试可靠性和一致性。本研究从连续两晚在实验室进行多导睡眠图（PSG）的一组年龄较大（≥55 岁）、主要不嗜睡、社区居住的志愿者中，确定了 PUP 估计生理因素的测试 - 再测试可靠性和一致性。
纳入第一晚呼吸暂停低通气指数（AHI3A）至少为每小时 15 次的参与者。对每位参与者的两次 PSG 中的每一次进行 PUP 分析。使用组内相关系数评估可靠性，最小真实差异（SRD）评估一致性，对来自 NREM 睡眠的生理因素估计值进行比较。
分析了 43 名参与者（共 86 名）的两次 PSG。第二晚睡眠时间、稳定性增加，OSA 严重程度降低，出现了第一晚效应。LG1、ArTH 和 Vpassive 具有良好的可靠性（ICC > 0.80）。Vcomp 具有中等可靠性（ICC = 0.67）。对于所有生理因素，SRD 值约为观察范围的 20%或更高，这表明对于给定个体，纵向测量的一致性有限。
对于认知正常的 OSA 老年个体的 NREM 睡眠，PUP 估计的 LG1、ArTH 和 Vpassive 在短期重复测量中显示出个体的一致相对排名（良好的可靠性）。对于所有生理因素，纵向测量在夜间显示出个体内的大量变异性（一致性有限）。
