Hynes Daniel J, Mann Dwayne L, Landry Shane A, Joosten Simon A, Edwards Bradley A, Hamilton Garun S
Monash Lung, Sleep, Allergy and Immunology, Monash Health, Victoria, Australia.
School of Clinical Sciences, Monash University, Victoria, Australia.
Sleep. 2025 Apr 11;48(4). doi: 10.1093/sleep/zsae295.
There is substantial night-to-night variability (NtNV) in obstructive sleep apnea (OSA) severity in some individuals; however, predictors for this remain incompletely understood. This study aims to quantify the degree of NtNV in the apnea-hypopnea index (AHI), hypoxic burden, airflow limitation, and OSA endotypes; to determine if a relationship exists between the degree of NtNV in AHI and in endotype expression; to assess whether the degree of flow-limited breathing is predictive of the degree of NtNV of the AHI.
Seventy-one patients with OSA underwent 2 polysomnograms (PSGs). OSA endotypes, hypoxic burden, and flow limitation frequency were extracted from PSG data. Intraindividual agreement was assessed and associations with the NtNV of the AHI were calculated. Patients were grouped into High Variability vs Low Variability based on the degree of difference in AHI between each night.
Despite wide limits of agreement, at the group level most PSG and endotype variables were not statistically different between first and second night. Flow limitation frequency was 7.7% (2.1-13, p < 0.01) higher on the second night compared to baseline. There were weak linear associations between NtNV of endotypes and NtNV of the AHI. In subgroup analysis, there was greater difference between nights for Vactive (5%eupnea, p = 0.01), Vpassive (3.1%eupnea, p = 0.03), Vcomp (3.2%eupnea, p = 0.01), and arousal threshold (4.1%eupnea, p = 0.04) in the High-Variability compared to the Low-Variability group.
There is high NtNV in AHI, OSA endotypes, and flow limitation in some individuals; however, no strong linear relationship exists between these changes.
Combined Upper-airway and Breathing Control Therapies for Obstructive Sleep Apnea (https://clinicaltrials.gov/study/NCT03189173?term=NCT03189173&rank=1, NCT03189173). Pharmacological Intervention for Symptomatic Mild Sleep Disordered Breathing (https://clinicaltrials.gov/study/NCT04611750?term=NCT04611750&rank=1, NCT04611750). Combination Pharmacological Interventions for Multiple Mechanisms of Obstructive Sleep Apnea (https://clinicaltrials.gov/study/NCT03892772?term=NCT03892772&rank=1, NCT03892772).
部分个体的阻塞性睡眠呼吸暂停（OSA）严重程度存在显著的夜间变异性（NtNV）；然而，其预测因素仍未完全明确。本研究旨在量化呼吸暂停低通气指数（AHI）、低氧负荷、气流受限及OSA内型中的NtNV程度；确定AHI中的NtNV程度与内型表达程度之间是否存在关联；评估气流受限呼吸程度是否可预测AHI的NtNV程度。
71例OSA患者接受了2次多导睡眠图（PSG）检查。从PSG数据中提取OSA内型、低氧负荷及气流受限频率。评估个体内一致性，并计算与AHI的NtNV的相关性。根据每晚AHI差异程度将患者分为高变异性组和低变异性组。
尽管一致性界限较宽，但在组水平上，大多数PSG和内型变量在第一晚和第二晚之间无统计学差异。与基线相比，第二晚气流受限频率高7.7%（2.1 - 13，p < 0.01）。内型的NtNV与AHI的NtNV之间存在弱线性关联。在亚组分析中，与低变异性组相比，高变异性组中Vactive（5%平静呼吸，p = 0.01）、Vpassive（3.1%平静呼吸，p = 0.03）、Vcomp（3.2%平静呼吸，p = 0.01）和觉醒阈值（4.1%平静呼吸，p = 0.04）在夜间的差异更大。
部分个体在AHI、OSA内型及气流受限方面存在较高的NtNV；然而，这些变化之间不存在强线性关系。
