唤醒阈值会改变持续气道正压通气对阻塞性睡眠呼吸暂停患者执行功能的影响。
Arousal threshold modifies the effect of CPAP on executive function among individuals with obstructive sleep apnoea.
作者信息
Zinchuk Andrey V, Kushida Clete A, Walker Alexander, Wellman Andrew, Azarbarzin Ali, Alex Raichel M, Varga Andrew W, Sands Scott A, Yaggi H Klar
机构信息
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, USA.
出版信息
Eur Respir J. 2025 Feb 13;65(2). doi: 10.1183/13993003.01183-2024. Print 2025 Feb.
BACKGROUND
Obstructive sleep apnoea (OSA) is associated with neurocognitive dysfunction. However, randomised trials evaluating the effects of continuous positive airway pressure (CPAP) on neurocognition in those without dementia do not show a benefit. We thus aimed to assess whether arousal threshold (ArTH) modifies the effect of CPAP on neurocognitive function.
METHODS
We performed a secondary analysis of a randomised, sham-controlled trial (Apnea Positive Pressure Long-term Efficacy Study (APPLES); ClinicalTrials.gov: NCT00051363). ArTH was estimated from polysomnography using a translatable method. Neurocognitive outcomes included the Sustained Working Memory Test-Overall Mid-Day (SWMT-OMD) score (executive function, primary outcome), with the Pathfinder Number Test total time (attention) and Buschke Selective Reminding Test sum recall (learning and memory) as secondary outcomes. Generalised linear modelling assessed whether the effect of CPAP was modified by baseline ArTH (treatment×ArTH interaction). 833 participants with OSA (apnoea-hypopnoea index ≥10 events·h), available ArTH and outcomes were analysed (active CPAP n=437 and sham CPAP n=396).
RESULTS
For executive function, the effect of CPAP treatment was modified by ArTH (p=0.042). Specifically, for every 1sd increase in ArTH, the SWMT-OMD score improved by 0.091 (95% CI 0.003-0.178) in active compared to sham CPAP at 6 months; at ArTH 1sd above the mean, SWMT-OMD improvements were nearly three times that in those with average ArTH (0.139 (95% CI 0.018-0.261) 0.053 (95% CI -0.034-0.140), respectively). No effect modification was observed for attention (p=0.311) or learning and memory (p=0.744).
CONCLUSION
In OSA, a higher ArTH is associated with greater improvements in executive function following CPAP therapy.
背景
阻塞性睡眠呼吸暂停（OSA）与神经认知功能障碍有关。然而，评估持续气道正压通气（CPAP）对无痴呆患者神经认知影响的随机试验并未显示出有益效果。因此，我们旨在评估觉醒阈值（ArTH）是否会改变CPAP对神经认知功能的影响。
方法
我们对一项随机、假对照试验（呼吸暂停正压长期疗效研究（APPLES）；ClinicalTrials.gov：NCT00051363）进行了二次分析。使用一种可转化的方法从多导睡眠图估计ArTH。神经认知结果包括持续工作记忆测试-全天中午（SWMT-OMD）评分（执行功能，主要结果），以探路者数字测试总时间（注意力）和布施克选择性提醒测试总回忆（学习和记忆）作为次要结果。广义线性模型评估CPAP的效果是否因基线ArTH而改变（治疗×ArTH相互作用）。分析了833名患有OSA（呼吸暂停低通气指数≥10次·小时）、有可用ArTH和结果的参与者（主动CPAP组n = 437，假CPAP组n = 396）。
结果
对于执行功能，CPAP治疗的效果因ArTH而改变（p = 0.042）。具体而言，ArTH每增加1个标准差，在6个月时，与假CPAP相比，主动CPAP组的SWMT-OMD评分提高0.091（95%CI 0.003 - 0.178）；在ArTH高于平均值1个标准差时，SWMT-OMD的改善几乎是平均ArTH者的三倍（分别为0.139（95%CI 0.018 - 0.261）和0.053（95%CI -0.034 - 0.140））。对于注意力（p = 0.311）或学习和记忆（p = 0.744）未观察到效果改变。
结论
在OSA中，较高的ArTH与CPAP治疗后执行功能的更大改善相关。
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