Park Dong Heun, Choi Hangseok, Nam Kukjin, Lee Seung Hoon, Seo Min Young
Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Medical Science Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea.
J Rhinol. 2024 Jul;31(2):86-92. doi: 10.18787/jr.2024.00014. Epub 2024 Jul 31.
This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy.
In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment.
Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m) than in the persistent EDS group (27.13 kg/m; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p<0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p<0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p<0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p<0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p<0.001) and multivariate (OR=0.973, p=0.019) analyses.
Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient's self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.
本研究旨在评估影响阻塞性睡眠呼吸暂停（OSA）患者在接受气道正压通气（PAP）治疗后深度睡眠恢复的因素。
共有363例被诊断为OSA且接受PAP治疗至少3个月的患者纳入本研究。根据PAP治疗3个月前后白天嗜睡和晨起头痛的情况，评估多导睡眠图参数、解剖学特征以及与睡眠相关的主观参数。
根据白天过度嗜睡（EDS）是否缓解（平均年龄：49.35岁）或持续存在（平均年龄：52.82岁），年龄存在显著差异（p = 0.001）。年龄与晨起头痛也显著相关（p = 0.037）。EDS缓解组的体重指数（BMI）高于EDS持续组（28.70kg/m²比27.13kg/m²；p = 0.002）。呼吸暂停低通气指数（AHI）与EDS结局相关（p = 0.011）。EDS缓解组的下颌平面至舌骨距离（MPH）长于EDS持续组（17.95mm对15.38mm；p<0.001）。然而，BMI、AHI和MPH与晨起头痛无显著关联。在EDS缓解组和晨起头痛缓解组中，爱泼沃斯嗜睡量表评分更高（EDS：p<0.001，晨起头痛：p = 0.001）。睡眠呼吸暂停自我效能量表（SEMSA）值在EDS组间差异显著（p<0.001），但在晨起头痛组间无显著差异（p = 0.122）。PAP治疗3个月后，单因素分析（比值比[OR]=0.921，p<0.001）和多因素分析（OR=0.937，p = 0.028）显示MPH与EDS呈负相关。单因素分析（OR=0.961，p<0.001）和多因素分析（OR=0.973，p = 0.019）显示SEMSA评分也与EDS呈负相关。
年龄、多导睡眠图指标和解剖学因素对于与睡眠质量相关的白天症状很重要。此外，解剖学特征和患者的自我效能与PAP治疗对睡眠质量的影响显著相关。
