Coso Carlota, Solano-Pérez Esther, Romero-Peralta Sofía, Castillo-García María, Silgado-Martínez Laura, López-Monzoni Sonia, Resano-Barrio Pilar, Cano-Pumarega Irene, Sánchez-de-la-Torre Manuel, Mediano Olga
Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain.
Rev Cardiovasc Med. 2024 May 16;25(5):172. doi: 10.31083/j.rcm2505172. eCollection 2024 May.
Obstructive sleep apnea (OSA) is a highly prevalent sleep-disordered breathing. It is associated with adverse co-morbidities, being the most scientific evidence of cardiovascular (CV) disease. Currently, OSA is measured through the apnea-hypopnea index (AHI), the total number of respiratory events per hour of sleep. However, different studies have questioned its utility in OSA management, highlighting the need to search for new parameters that better reflect the heterogeneity of the disease. Hypoxic burden (HB) has emerged as a novel biomarker that informs about the frequency, duration and depth of the desaturation related to the respiratory events. We conducted a systematic review in order to find publications about the heterogeneity of OSA measured by HB and its associations with future disease.
Systematic review was conducted using PubMed and Web of Science. The terms "sleep apne" and "hypoxic burden" were used to look for publications from the date of inception to August 15, 2023. Inclusion criteria: articles in English published in peer-reviewed journals. Exclusion criteria: (1) not available publications; (2) duplicated articles; (3) letters, editorials, and congress communications; (4) articles not including information about HB as a specific biomarker of OSA.
33 studies were included. The results were classified in 2 main sections: (1) HB implication in the CV sphere: HB showed to be a better predictor of CV risk in OSA patients than traditional measures such as AHI with possible clinical management implication in OSA. (2) HB response to OSA treatment: pharmacological and nonpharmacological treatments have demonstrated to be effective in improving hypoxia measured through the HB.
HB could be a better and more effective parameter than traditional measurements in terms of diagnosis, risk prediction and therapeutic decisions in patients with OSA. This measure could be incorporated in sleep units and could play a role in OSA management, driving the clinic to a more personalized medicine.
阻塞性睡眠呼吸暂停（OSA）是一种高度常见的睡眠呼吸紊乱疾病。它与不良合并症相关，是心血管（CV）疾病最具科学依据的关联因素。目前，OSA通过呼吸暂停低通气指数（AHI）来衡量，即每小时睡眠中呼吸事件的总数。然而，不同研究对其在OSA管理中的效用提出了质疑，强调需要寻找能更好反映该疾病异质性的新参数。缺氧负荷（HB）已成为一种新的生物标志物，可反映与呼吸事件相关的血氧饱和度降低的频率、持续时间和深度。我们进行了一项系统综述，以查找关于通过HB测量的OSA异质性及其与未来疾病关联的出版物。
使用PubMed和Web of Science进行系统综述。使用“睡眠呼吸暂停”和“缺氧负荷”等术语查找从创刊日期至2023年8月15日的出版物。纳入标准：在同行评审期刊上发表的英文文章。排除标准：（1）不可获取的出版物；（2）重复文章；（3）信件、社论和国会通讯；（4）不包括关于HB作为OSA特定生物标志物信息的文章。
纳入33项研究。结果分为2个主要部分：（1）HB在心血管领域的影响：与传统指标如AHI相比，HB在OSA患者中是更好的心血管风险预测指标，对OSA可能具有临床管理意义。（2）HB对OSA治疗的反应：药物和非药物治疗已证明可有效改善通过HB测量的缺氧情况。
在OSA患者的诊断、风险预测和治疗决策方面，HB可能是比传统测量更好、更有效的参数。该指标可纳入睡眠单元，并在OSA管理中发挥作用，推动临床走向更个性化的医疗。
