Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland; Barmelweid Academy, Clinic Barmelweid, Barmelweid, Switzerland; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland.
Sleep Med. 2024 Jan;113:338-341. doi: 10.1016/j.sleep.2023.12.002. Epub 2023 Dec 6.
/Background: The change in cerebral hemodynamics induced by sleep apneas and hypopneas may contribute to the daytime sleepiness in patients with obstructive sleep apnea (OSA). However, previous studies failed to discovery their relationship. We propose and test a new parameter, the cumulative brain oxygen desaturation, which may contribute to OSA patient's daytime sleepiness.
PATIENTS/METHODS: 22 patients with severe OSA (apnea-hypopnea index (AHI) at diagnosis [mean ± standard deviation, std.]: 52.1 ± 21.6/h, median: 45.1/h, interquartile range: 34.4-60.2/h) were monitored by polysomnography during routine continuous positive airway pressure titration. The reductions of brain tissue oxygen saturation (StO2) in all respiratory events at baseline sleep were measured by frequency-domain near-infrared spectroscopy (NIRS). The cumulative brain desaturation was calculated as AHI times the mean StO2 desaturation (i.e., AHI×ΔStO2‾). Similarly, cumulative peripheral desaturation was also calculated, i.e., AHI×ΔSpO2‾ where ΔSpO2‾ was the mean reduction of peripheral arterial oxygen saturation (SpO2). The correlations between Epworth sleepiness scale (ESS) and AHI, ΔStO2‾, AHI×ΔStO2‾, and AHI×ΔSpO2‾ were tested, respectively. Linear regression was applied to predict ESS using AHI×ΔStO2‾ and AHI×ΔSpO2‾, with age and BMI as covariates.
ESS significantly correlates to the cumulative brain desaturation (Pearson's correlation coefficient: 0.68, p = 0.00056), not the other parameters. Regression analysis only finds significant association between ESS and the cumulative cerebral desaturation (p = 0.00195) but not the cumulative peripheral desaturation (p = 0.71).
The cumulative brain oxygen desaturation, which comprehensively combines total sleep time, the frequency of apnea and hypopnea events, and the severity of cerebral oxygen desaturation, is a new indicator for daytime sleepiness in severe OSA.
/背景：睡眠呼吸暂停和低通气引起的脑血流变化可能导致阻塞性睡眠呼吸暂停（OSA）患者白天嗜睡。然而，先前的研究未能发现它们之间的关系。我们提出并测试了一个新的参数，即累积脑氧去饱和，它可能与 OSA 患者的白天嗜睡有关。
患者/方法：22 例重度 OSA 患者（诊断时的呼吸暂停低通气指数（AHI）[平均值±标准差，std.]：52.1±21.6/小时，中位数：45.1/小时，四分位距：34.4-60.2/小时）在常规持续气道正压通气滴定过程中通过多导睡眠图进行监测。基线睡眠时所有呼吸事件中脑组织氧饱和度（StO2）的降低通过频域近红外光谱（NIRS）进行测量。累积脑去饱和量计算为 AHI 乘以平均 StO2 去饱和量（即 AHI×ΔStO2‾）。同样，也计算了累积外周去饱和量，即 AHI×ΔSpO2‾，其中 ΔSpO2‾是外周动脉血氧饱和度（SpO2）的平均降低量。分别测试了 Epworth 嗜睡量表（ESS）与 AHI、ΔStO2‾、AHI×ΔStO2‾和 AHI×ΔSpO2‾之间的相关性。使用 AHI×ΔStO2‾和 AHI×ΔSpO2‾作为协变量，应用线性回归预测 ESS。
ESS 与累积脑去饱和量显著相关（Pearson 相关系数：0.68，p=0.00056），而与其他参数无关。回归分析仅发现 ESS 与累积脑去饱和量之间存在显著关联（p=0.00195），而与累积外周去饱和量无关（p=0.71）。
累积脑氧去饱和量综合了总睡眠时间、呼吸暂停和低通气事件的频率以及脑氧去饱和的严重程度，是重度 OSA 患者白天嗜睡的一个新指标。
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