睡眠呼吸暂停的生理负担与白质损伤标志物：动脉粥样硬化的多民族研究
Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis.
作者信息
Hajipour Mohammadreza, Hu Wen-Hsin, Esmaeili Neda, Sands Scott, Wellman Andrew, Kwon Younghoon, Labarca Gonzalo, Nasrallah Ilya M, Bryan R Nick, Strollo Patrick J, Heckbert Susan R, Redline Susan, Ayas Najib T, Azarbarzin Ali
机构信息
Division of Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
J Clin Sleep Med. 2025 Mar 1;21(3):457-466. doi: 10.5664/jcsm.11422.
STUDY OBJECTIVES
Obstructive sleep apnea is associated with cognitive impairment; however, the underlying mechanisms remain incompletely understood. Obstructive sleep apnea is characterized by periods of interrupted ventilation (ventilatory burden), leading to hypoxemia (hypoxic burden) and/or arousal (arousal burden) from sleep. Although hypoxemia is considered a key mechanism underlying white matter injury, its measurement has been limited. In our primary analysis, we assessed the association of hypoxic burden, a quantitative measure of hypoxemia, with white matter hyperintensity volume, a marker of small vessel disease, and compared it with that of ventilatory burden and arousal burden (quantitative measures of ventilatory deficit and arousals).
METHODS
Data from participants in the Multi-Ethnic Study of Atherosclerosis with full polysomnograms and brain magnetic resonance imaging were analyzed. Hypoxic burden was defined as the total area under the oxygen desaturation curve per hour of sleep, ventilatory burden was defined as the event-specific area under the ventilation signal, and arousal burden was defined as the normalized cumulative duration of all arousals. The primary outcome was white matter hyperintensity volume, with other magnetic resonance imaging measures considered secondary outcomes.
RESULTS
The analysis included polysomnograms from 587 participants (age: 65.5 ± 8.2 years). In the fully adjusted model, each 1 standard deviation increase in hypoxic burden was associated with a 0.09 standard deviation increase in white matter hyperintensity volume ( = .023), after adjusting for demographics, study site, and comorbidities. In contrast, ventilatory burden, arousal burden, and conventional obstructive sleep apnea measures were not associated with outcomes.
CONCLUSIONS
Hypoxic burden was associated with white matter hyperintensity volume in a racially/ethnically diverse cohort of older individuals with a high prevalence of obstructive sleep apnea .
CITATION
Hajipour M, Hu W-H, Esmaeili N, et al. Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis. 2025;21(3):457-466.
研究目的
阻塞性睡眠呼吸暂停与认知障碍有关；然而，其潜在机制仍未完全明确。阻塞性睡眠呼吸暂停的特征是通气中断（通气负担），导致低氧血症（缺氧负担）和/或睡眠中觉醒（觉醒负担）。虽然低氧血症被认为是白质损伤的关键机制，但其测量方法有限。在我们的初步分析中，我们评估了缺氧负担（低氧血症的定量指标）与白质高信号体积（小血管疾病的标志物）之间的关联，并将其与通气负担和觉醒负担（通气不足和觉醒的定量指标）进行比较。
方法
分析了来自多民族动脉粥样硬化研究中具有完整多导睡眠图和脑磁共振成像的参与者的数据。缺氧负担定义为每小时睡眠中氧饱和度下降曲线下的总面积，通气负担定义为通气信号下特定事件的面积，觉醒负担定义为所有觉醒的标准化累积持续时间。主要结局是白质高信号体积，其他磁共振成像测量指标被视为次要结局。
结果
分析纳入了587名参与者的多导睡眠图（年龄：65.5±8.2岁）。在完全调整模型中，在调整了人口统计学、研究地点和合并症后，缺氧负担每增加1个标准差，白质高信号体积增加0.09个标准差（P=0.023）。相比之下，通气负担、觉醒负担和传统的阻塞性睡眠呼吸暂停测量指标与结局无关。
结论
在阻塞性睡眠呼吸暂停患病率较高的不同种族/民族的老年人群中，缺氧负担与白质高信号体积有关。
引用文献
Hajipour M, Hu W-H, Esmaeili N, et al. Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis. 2025;21(3):457-466.
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