Laboratorio do Sono, LIM 63, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Sleep and Circadian Medicine Laboratory, Department of Physiology and School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Sci Rep. 2023 May 11;13(1):7638. doi: 10.1038/s41598-023-34002-4.
Insomnia and obstructive sleep apnea (OSA) are common sleep disorders and frequently coexist (COMISA). Arousals from sleep may be a common link explaining the frequent comorbidity of both disorders. Respiratory arousal threshold (AT) is a physiologic measurement of the level of respiratory effort to trigger an arousal from sleep. The impact of COMISA on AT is not known. We hypothesized that a low AT is more common among COMISA than among patients with OSA without insomnia. Participants referred for OSA diagnosis underwent a type 3 sleep study and answered the insomnia severity index (ISI) questionnaire and the Epworth sleepiness scale. Participants with an ISI score ≥ 15 were defined as having insomnia. Sleep apnea was defined as an apnea hypopnea index (AHI) ≥ 15 events/h. Low AT was determined using a previously validated score based on 3 polysomnography variables (AHI, nadir SpO and the frequency of hypopneas). OSA-only (n = 51) and COMISA (n = 52) participants had similar age (61[52-68] vs 60[53-65] years), body-mass index (31.3[27.7-36.2] vs 32.2[29.5-38.3] kg/m) and OSA severity (40.2[27.5-60] vs 37.55[27.9-65.2] events/h): all p = NS. OSA-only group had significantly more males than the COMISA group (58% vs 33%, p = 0.013. The proportion of participants with a low AT among OSA-only and COMISA groups was similar (29 vs 33%, p = NS). The similar proportion of low AT among COMISA and patients with OSA suggests that the respiratory arousal threshold may not be related to the increased arousability of insomnia.
失眠和阻塞性睡眠呼吸暂停（OSA）是常见的睡眠障碍，且常同时存在（COMISA）。睡眠时的觉醒可能是解释这两种疾病经常同时发生的共同联系。呼吸觉醒阈值（AT）是一种生理测量，用于测量触发睡眠觉醒的呼吸努力程度。COMISA 对 AT 的影响尚不清楚。我们假设 COMISA 患者的低 AT 比单纯 OSA 患者更常见，而单纯 OSA 患者无失眠。被转介进行 OSA 诊断的参与者接受了 3 型睡眠研究，并回答了失眠严重指数（ISI）问卷和嗜睡量表。ISI 评分≥15 的参与者被定义为患有失眠。睡眠呼吸暂停定义为呼吸暂停低通气指数（AHI）≥15 次/小时。低 AT 是通过使用基于 3 项多导睡眠图变量（AHI、最低 SpO 和呼吸暂停频率）的先前验证评分来确定的。单纯 OSA（n=51）和 COMISA（n=52）参与者的年龄（61[52-68]与 60[53-65]岁）、体重指数（31.3[27.7-36.2]与 32.2[29.5-38.3]kg/m）和 OSA 严重程度（40.2[27.5-60]与 37.55[27.9-65.2]次/小时）相似（均为 p>NS）。单纯 OSA 组的男性明显多于 COMISA 组（58%比 33%，p=0.013）。单纯 OSA 组和 COMISA 组低 AT 比例相似（29%比 33%，p=NS）。COMISA 和单纯 OSA 患者低 AT 比例相似表明，呼吸觉醒阈值可能与失眠的易激惹性增加无关。
