Blanchard Margaux, Imler Théo, Hu Wen-Hsin, Waeber Adrien, Solelhac Geoffroy, Haba-Rubio José, Kerbrat Sandrine, Sabil Abdelkebir, Trzepizur Wojciech, Goupil François, Thomas Audrey, Bailly Sébastien, Azarbarzin Ali, Vollenweider Peter, Marques-Vidal Pedro, Vaucher Julien, Heinzer Raphael, Gagnadoux Frédéric
Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France.
Co-first authors.
Eur Respir J. 2025 May 6;65(5). doi: 10.1183/13993003.01883-2024. Print 2025 May.
Sleep apnoea-specific heart rate response (ΔHR) has been identified as a promising biomarker for stratifying cardiovascular (CV) risk and predicting positive airway pressure (PAP) benefit in obstructive sleep apnoea (OSA). However, the need for prior manual scoring of respiratory events potentially limits the accessibility and reproducibility of ΔHR. We aimed to evaluate the association of pulse rate response to oxygen desaturations automatically derived from pulse oximetry (ΔHR) with CV risk in OSA.
ΔHR and ΔHR were measured in OSA patients from the Institut de Recherche en Santé Respiratoire Pays de la Loire Sleep Cohort (PLSC; n=5002) and the HypnoLaus cohort (n=1307). The primary outcome was major adverse CV events (MACEs), a composite of mortality, stroke and cardiac diseases. Cox regression analyses were conducted to evaluate the association of ΔHR and ΔHR, categorised into low, midrange and high categories, with MACEs.
MACEs occurred in 768 patients from PLSC and 87 patients from HypnoLaus (median follow-up 8.0 and 7.5 years, respectively). Multivariable Cox models showed that subjects with high ΔHR ( midrange) had higher risk of MACEs in PLSC (hazard ratio (HR) 1.42, 95% CI 1.18-1.71) and HypnoLaus (HR 1.72, 95% CI 1.03-2.87). Similar findings were observed for high ΔHR. Among 2718 patients from PLSC treated with PAP, the association of PAP adherence (PAP use ≥4 h·night non-adherent) with MACEs was modified by baseline ΔHR and ΔHR (p<0.05).
ΔHR could constitute a reliable and easy to measure biomarker for stratifying CV risk and predicting CV benefit of PAP in OSA.
睡眠呼吸暂停特异性心率反应（ΔHR）已被确定为一种有前景的生物标志物，可用于对阻塞性睡眠呼吸暂停（OSA）患者的心血管（CV）风险进行分层，并预测持续气道正压通气（PAP）治疗的获益情况。然而，呼吸事件需要事先进行人工评分，这可能会限制ΔHR的可及性和可重复性。我们旨在评估通过脉搏血氧饱和度自动得出的对氧饱和度下降的脉搏率反应（ΔHR）与OSA患者CV风险之间的关联。
在卢瓦尔河谷地区呼吸健康研究所睡眠队列（PLSC；n = 5002）和HypnoLaus队列（n = 1307）的OSA患者中测量ΔHR和ΔHR。主要结局是主要不良心血管事件（MACE），即死亡率、中风和心脏病的综合指标。进行Cox回归分析，以评估分为低、中、高三个类别的ΔHR和ΔHR与MACE之间的关联。
PLSC队列中有768例患者发生MACE，HypnoLaus队列中有87例患者发生MACE（中位随访时间分别为8.0年和7.5年）。多变量Cox模型显示，在PLSC队列中，ΔHR高（中范围）的受试者发生MACE的风险更高（风险比[HR] 1.42，95%置信区间[CI] 1.18 - 1.71），在HypnoLaus队列中也是如此（HR 1.72，95% CI 1.03 - 2.87）。对于高ΔHR也观察到了类似的结果。在PLSC队列中接受PAP治疗的2718例患者中，PAP依从性（PAP使用≥4小时/晚与不依从）与MACE之间的关联受到基线ΔHR和ΔHR的影响（p<0.05）。
ΔHR可能是一种可靠且易于测量的生物标志物，可用于对OSA患者的CV风险进行分层，并预测PAP治疗对CV的获益情况。
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