Weinberger Marina, Ahmed Anwar E, Almuttari Ahmed, Al-Harbi Abdullah, Alsaigh Hani A, Kent Werner J, Al-Jahdali Hamdan
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Behav Neurol. 2025 Apr 3;2025:8848485. doi: 10.1155/bn/8848485. eCollection 2025.
The clinical utility of the ratio of the apnea-hypopnea index (AHI) occurring during rapid eye movement (REM) and non-REM (NREM) sleep (AHI/AHI ratio) has been debated. We investigated the heterogeneity of REM and NREM sleep behaviors to identify unobserved distinct subtypes of sleep-disordered breathing (SDB) and examine their demographic and clinical features. The present study used a sample of 3626 adult patients who underwent diagnostic polysomnography evaluations at the Sleep Disorders Center of King Abdulaziz Medical City in Riyadh, Saudi Arabia. Latent profile analysis was performed to categorize subjects into distinct profiles of SDB based on AHI, AHI, and AHI/AHI ratio. A multinomial logistic model estimated the odds ratio of SDB profiles. Four distinct subtypes of SDB were identified: Class I (low AHI; 75.9%) included patients with normal SDB events during REM sleep, serving as the reference group; Class II (REM-OSA, 1.2%) included patients with high AHI during REM sleep but lowest AHI during NREM sleep, resulting in the largest AHI/AHI ratio; Class III (AHI < 30 events per hour, 17.4%); and Class IV (AHI ≥ 30 events per hour, 5.5%). Compared to Class I, factors related to Class IV included older age, high BMI, large neck circumference, hypertension, reduced total sleep time, reduced REM sleep, poor sleep efficiency, high desaturation index, low SpO2, high arousal index, and high Epworth Sleepiness Scale. As hypothesized, the study characterized several subtypes of SDB based on the AHI, AHI, and their ratio (AHI/AHI) in a large cohort and identified their demographic and clinical features. These subtypes might be clinically useful for defining SDB among adult patients referred to sleep clinics who may have varying responses to treatment depending on their subtype of the disease.
快速眼动（REM）睡眠期与非快速眼动（NREM）睡眠期呼吸暂停低通气指数（AHI）比值（AHI/AHI比值）的临床效用一直存在争议。我们研究了REM和NREM睡眠行为的异质性，以识别未被观察到的睡眠呼吸障碍（SDB）不同亚型，并检查其人口统计学和临床特征。本研究使用了3626名成年患者的样本，这些患者在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城睡眠障碍中心接受了诊断性多导睡眠图评估。基于AHI、AHI和AHI/AHI比值，进行潜在类别分析以将受试者分类为不同的SDB类别。多项逻辑模型估计了SDB类别的优势比。识别出了四种不同的SDB亚型：I类（低AHI；75.9%）包括REM睡眠期SDB事件正常的患者，作为参考组；II类（REM-OSA，1.2%）包括REM睡眠期AHI高但NREM睡眠期AHI最低的患者，导致最大的AHI/AHI比值；III类（AHI每小时<30次事件，17.4%）；IV类（AHI每小时≥30次事件，5.5%）。与I类相比，与IV类相关的因素包括年龄较大、BMI高、颈围大、高血压、总睡眠时间减少、REM睡眠减少、睡眠效率差、去饱和指数高、SpO2低、觉醒指数高和Epworth嗜睡量表评分高。正如所假设的，该研究在一个大型队列中根据AHI、AHI及其比值（AHI/AHI）对几种SDB亚型进行了特征描述，并识别了其人口统计学和临床特征。这些亚型在临床上可能有助于在转诊至睡眠诊所的成年患者中定义SDB，这些患者可能根据其疾病亚型对治疗有不同反应。
