Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Pulmonary and Critical Care Medicine, Lhasa People's Hospital, Lhasa City, Tibet Autonomous Region, China.
Sleep Med. 2023 Oct;110:146-153. doi: 10.1016/j.sleep.2023.08.003. Epub 2023 Aug 5.
/Background: This study aimed to explore the clinical, polysomnographic, and heart rate variability (HRV) characteristics of highland obstructive sleep apnea (OSA) patients receiving one-night nocturnal oxygen supplementation (NOS) and to identify factors predicting response.
PATIENTS/METHODS: Thirty-four highland OSA patients living in Shangri-La were randomly assigned to receive NOS and sham oxygen in a randomized, placebo-controlled, crossover trial. Clinical assessments, polysomnography, and HRV were measured. A responder was defined as a ≥50% reduction in apnea-hypopnea index (AHI) with NOS compared with sham oxygen.
Eighteen participants responded and 16 did not respond, with a median (interquartile range [IQR]) age of 46.5 (36.5-53.0) and 48.0 (44.3-53.3) years, respectively. The median treatment effect (95% CI) on total AHI was -23.2/h (-30.0 to -17.5) and -12.0/h (-16.6 to -7.6) in responders and non-responders (p = 0.004), with similar effects on oxygen desaturation index. The mean OAH duration was prolonged by 7 s in responders together with improved sleep quality and daytime blood pressure. The mean OAH duration at baseline predicted responses to NOS with a sensitivity and specificity of 88.9% and 68.7% (AUC 0.809) at a cut-off point of 24.9 s. Changes in HRV parameters were negatively correlated with changes in mean oxygen saturation and daytime systolic blood pressure only in responders.
NOS significantly improved OSA severity and clinical outcomes in responders, which was related to improvements in parasympathetic activity. Highlanders with shorter mean OAH may be suitable candidates for NOS. These findings provide new information about tailored treatment strategies for highland OSA patients.
/背景：本研究旨在探讨接受一夜夜间氧疗（N0S）的高原阻塞性睡眠呼吸暂停（OSA）患者的临床、多导睡眠图和心率变异性（HRV）特征，并确定预测反应的因素。
患者/方法：34 名居住在香格里拉的高原 OSA 患者被随机分配到接受 NOS 和假氧的随机、安慰剂对照、交叉试验中。测量临床评估、多导睡眠图和 HRV。将 NOS 与假氧相比 AHI 降低≥50%的患者定义为反应者。
18 名参与者有反应，16 名无反应，中位数（四分位距[IQR]）年龄分别为 46.5（36.5-53.0）和 48.0（44.3-53.3）岁。总 AHI 的中位数（95%CI）治疗效应在反应者和非反应者中分别为-23.2/h（-30.0 至-17.5）和-12.0/h（-16.6 至-7.6）（p=0.004），对氧减饱和度指数的影响相似。反应者的平均 OAH 持续时间延长了 7s，同时改善了睡眠质量和日间血压。反应者的基线平均 OAH 持续时间预测了对 NOS 的反应，其敏感性和特异性分别为 88.9%和 68.7%（AUC 0.809），截断点为 24.9s。HRV 参数的变化与反应者中平均氧饱和度和日间收缩压的变化呈负相关。
NOS 显著改善了反应者的 OSA 严重程度和临床结局，这与副交感神经活动的改善有关。平均 OAH 较短的高原居民可能是 NOS 的合适候选者。这些发现为高原 OSA 患者的个体化治疗策略提供了新的信息。
