Kalkanis Alexandros, Papadopoulos Dimitrios, Schiza Sophia, Hein Holger, Pataka Athanasia, Riha Renata, Fanfulla Francesco, Gouveris Haralampos, Bušková Jitka, Mihaicuta Stefan, Randerath Winfried, Pépin Jean-Louis, Grote Ludger, Testelmans Dries
Department of Pulmonology, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium.
Department of Pulmonology, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium.
Sleep Med. 2025 Mar;127:145-151. doi: 10.1016/j.sleep.2025.01.012. Epub 2025 Jan 21.
To assess the impact of the non-respiratory arousal burden at baseline polysomnography (PSG) on residual daytime sleepiness in positive airway pressure (PAP)-treated obstructive sleep apnea (OSA).
We included OSA patients from the European Sleep Apnea Database registry with available arousal data who had at least 2 treatment follow-up visits. The primary outcome was the Epworth Sleepiness Scale (ESS) score under PAP. The non-respiratory arousal ratio (NRAR) was defined as the ratio of non-respiratory to total arousals at baseline PSG. A linear mixed model tested the effect of NRAR tertiles on residual sleepiness. Baseline variables that differed significantly between groups were included as covariates.
800 patients with OSA (69.6 % male, mean age 57.1 ± 12.0 years, mean NRAR 0.22 ± 0.20) were evaluated during three follow up visits at a mean of 197.4, 499.3, and 731.6 days after PAP initiation. The interaction between time and NRAR tertile was statistically significant (F = 4.55, p = 0.001). The lowest NRAR tertile was associated with lower residual sleepiness over time compared to the highest NRAR tertile. The associations were independent of sex, comorbidities, body mass index, blood pressure, baseline apnea-hypopnea index, and baseline ESS score.
NRAR at baseline PSG predicts residual sleepiness in PAP-treated OSA patients. The findings offer new insights into OSA phenotyping and have important implications for patient care.
评估基线多导睡眠图（PSG）中非呼吸性觉醒负荷对经气道正压通气（PAP）治疗的阻塞性睡眠呼吸暂停（OSA）患者日间残余嗜睡的影响。
我们纳入了欧洲睡眠呼吸暂停数据库登记处的OSA患者，这些患者有可用的觉醒数据且至少有2次治疗随访。主要结局是PAP治疗下的爱泼沃斯嗜睡量表（ESS）评分。非呼吸性觉醒率（NRAR）定义为基线PSG中非呼吸性觉醒与总觉醒的比率。线性混合模型测试了NRAR三分位数对残余嗜睡的影响。将组间有显著差异的基线变量作为协变量纳入。
800例OSA患者（69.6%为男性，平均年龄57.1±12.0岁，平均NRAR为0.22±0.20）在PAP启动后的平均197.4、499.3和731.6天的三次随访中接受了评估。时间与NRAR三分位数之间的交互作用具有统计学意义（F = 4.55，p = 0.001）。与最高NRAR三分位数相比，最低NRAR三分位数随时间推移与较低的残余嗜睡相关。这些关联独立于性别、合并症、体重指数、血压、基线呼吸暂停低通气指数和基线ESS评分。
基线PSG时的NRAR可预测PAP治疗的OSA患者的残余嗜睡。这些发现为OSA表型分析提供了新的见解，并对患者护理具有重要意义。
