Ibrahim Nesrine Adly, Sankari Abdulghani, Aldwaikat Ahmad, Pandya Nishtha, Chowdhuri Susmita, Salloum Anan, Martin Jennifer L, Zeineddine Salam, Badr M Safwan
Department of Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.
Department of Internal Medicine, Wayne State University, Detroit, MI, USA.
Sleep Adv. 2024 Feb 5;5(1):zpae011. doi: 10.1093/sleepadvances/zpae011. eCollection 2024.
Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans.
Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea-hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic "CSA only" was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. "OSA only" was defined if AHI ≥ 10 events/hour and CAI < 5 events/hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI ≥ 10 events/hour and CAI > 5 events/hour but < 50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/hour on the titration study.
A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI ( < 0.05).
Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.
睡眠呼吸紊乱（SDB）在退伍军人中很常见。在这项回顾性研究中，我们调查了退伍军人中合并中枢性和阻塞性SDB的患病率以及对持续气道正压通气（PAP）的反应率。
从一家单一的退伍军人事务部（VA）医疗中心筛选出在2017年至2021年期间进行过多导睡眠图（PSG）研究的退伍军人，通过测量呼吸暂停低通气指数（AHI）和中枢性呼吸暂停指数（CAI）来确定SDB的存在、严重程度和类型。如果患者没有完整的研究（诊断和PAP滴定研究），则将其排除。这些分析的纳入标准是中枢性睡眠呼吸暂停（CSA），定义为AHI≥10次/小时且CAI≥5次/小时。诊断为“仅CSA”定义为AHI≥10次/小时且CAI≥AHI的50%。“仅阻塞性睡眠呼吸暂停（OSA）”定义为AHI≥10次/小时且CAI<5次/小时。如果AHI≥10次/小时且CAI>5次/小时但<AHI的50%，则定义为合并中枢性和阻塞性睡眠呼吸暂停（COSA）。根据滴定研究中CAI<5次/小时来确定对PAP治疗的反应性。
共有90名患者符合纳入标准，其中64名退伍军人被发现患有COSA（71%），18名（20%）仅患有CSA，8名（9%）仅患有OSA。共有22名（24.4%）被诊断为CSA或COSA的退伍军人对PAP治疗有反应。开始治疗60天后，有反应组和无反应组的AHI和CAI均显著下降（<0.05）。
合并中枢性和阻塞性SDB在退伍军人中很常见。对PAP治疗的反应不理想，但随时间推移有所改善。
