Op de Beeck Sara, Vena Daniel, Van de Perck Eli, Mann Dwayne, Azarbarzin Ali, Alex Raichel M, Dieltjens Marijke, Willemen Marc, Verbraecken Johan, Wellman Andrew, Sands Scott A, Vanderveken Olivier M
Universiteit Antwerpen Faculteit geneeskunde en gezondheidswetenschappen, Translational Neurosciences, Wilrijk, Belgium.
Universitair Ziekenhuis Antwerpen, Ear Nose Throat, Edegem, Belgium;
Ann Am Thorac Soc. 2025 May 29. doi: 10.1513/AnnalsATS.202408-871OC.
Both the site of upper airway collapse during drug-induced sleep endoscopy (DISE) and pathophysiological endotypic traits are associated with non-CPAP treatment outcomes for obstructive sleep apnea (OSA). Reduced hypoglossal nerve stimulation (HGNS) treatment efficacy has been associated with complete concentric collapse at the level of the palate (CCCp), lateral wall collapse, lower arousal threshold, and poor dilator muscle compensation. However, these predictors may not be independent. Currently, the relationship between the site of upper airway collapse (structure) and pathophysiological endotypic traits (function) remains unknown.
This retrospective cohort study examined 182 patients (median[95%CI], apnea-hypopnea index (AHI): 24.2[17.6,32.8], body-mass index (BMI): 27.8[25.2,30.5], age: 51.3[40.4,58.8]) who underwent in-laboratory polysomnography and DISE. All DISE studies were scored by one researcher, thereby avoiding inter-rater variability. Endotypic traits (loop gain, collapsibility, arousal threshold, and compensation) were estimated using routine polysomnography (Sands et al. AJRCCM 2018). Linear regression quantified differences in traits between DISE categories. Multivariable logistic regression quantified associations between DISE categories (dependent variable, with versus without a certain collapse type) and individual traits. Analyses were mutually adjusted for other endotypic traits.
CCCp was independently associated with greater collapsibility (Δ collapsibility = 9.8[4.6,15.0]%, p<0.001with vs. without CCCp, odds ratio = 6.9[95%CI:2.2,22.1] per 2SD increase in collapsibility [SD=15.9%];), but a lower arousal threshold (Δ arousal threshold =-8.4[-15.6,-1.2]%; OR=5.4[1.2,24.2] per 2SD [SD=24.9%];). Conversely, complete tongue base collapse was associated with less-severe collapsibility (Δ collapsibility =-5.9[-10.2,-1.6]%, OR=5.0[1.4, 17.9];), but a higher arousal threshold (Δ arousal threshold = 7.6[1.6,13.5]%, OR=5.7[1.4, 23.5];). Complete lateral wall collapse was independently associated with reduced compensation (Δ compensation =-8.0[-14.5,-1.5]%, p=0.018), OR=3.6[1.2, 10.4] per 2 SD [SD=17.5%]; whereas epiglottic collapse was associated with greater compensation (Δ compensation = 8.1[1.0,15.3]%, OR=5.8[1.1,31.2]). Findings persisted with additional adjustment for AHI and BMI, except for collapsibility and tongue base collapse. Loop gain was not associated with any site of collapse.
Different sites of upper airway collapse manifest distinctly different pathophysiological traits in OSA patients. The greater collapsibility and lower arousal threshold seen with CCCp and reduced compensation with lateral wall collapse may help explain reduced non-CPAP treatment efficacy in these populations. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
药物诱导睡眠内镜检查（DISE）中上气道塌陷的部位和病理生理内型特征均与阻塞性睡眠呼吸暂停（OSA）的非持续气道正压通气（CPAP）治疗结果相关。舌下神经刺激（HGNS）治疗效果降低与腭水平的完全同心塌陷（CCCp）、侧壁塌陷、较低的觉醒阈值和扩张肌代偿不良有关。然而，这些预测因素可能并非相互独立。目前，上气道塌陷部位（结构）与病理生理内型特征（功能）之间的关系尚不清楚。
这项回顾性队列研究检查了182例患者（中位数[95%CI]，呼吸暂停低通气指数（AHI）：24.2[17.6,32.8]，体重指数（BMI）：27.8[25.2,30.5]，年龄：51.3[40.4,58.8]），这些患者接受了实验室多导睡眠图检查和DISE。所有DISE研究均由一名研究人员评分，从而避免了评分者间的差异。使用常规多导睡眠图（Sands等人，《美国呼吸与危重症医学杂志》2018年）评估内型特征（环路增益、可塌陷性、觉醒阈值和代偿）。线性回归量化了DISE类别之间特征的差异。多变量逻辑回归量化了DISE类别（因变量，有或无某种塌陷类型）与个体特征之间的关联。分析针对其他内型特征进行了相互调整。
CCCp与更高的可塌陷性独立相关（可塌陷性差异=9.8[4.6,15.0]%，有CCCp与无CCCp相比，p<0.001，每2标准差增加的可塌陷性[标准差=15.9%]的优势比=6.9[95%CI：2.2,22.1]；），但觉醒阈值较低（觉醒阈值差异=-8.4[-15.6,-1.2]%；每2标准差[标准差=24.9%]的优势比=5.4[1.2,24.2]；）。相反，完全舌根塌陷与较轻的可塌陷性相关（可塌陷性差异=-5.9[-10.2,-1.6]%，优势比=5.0[1.4,17.9]；），但觉醒阈值较高（觉醒阈值差异=7.6[1.6,13.5]%，优势比=5.7[1.4,23.5]；）。完全侧壁塌陷与代偿降低独立相关（代偿差异=-8.0[-14.5,-1.5]%，p=0.018），每2标准差[标准差=17.5%]的优势比=3.6[1.2,10.4]；而会厌塌陷与更大的代偿相关（代偿差异=8.1[1.0,15.3]%，优势比=5.8[1.1,31.2]）。在对AHI和BMI进行额外调整后，除了可塌陷性和舌根塌陷外，其他结果仍然成立。环路增益与任何塌陷部位均无关联。
上气道塌陷的不同部位在OSA患者中表现出明显不同的病理生理特征。CCCp所见更高的可塌陷性和更低的觉醒阈值以及侧壁塌陷时代偿降低可能有助于解释这些人群中非CPAP治疗效果降低的原因。本文为开放获取文章，根据知识共享署名非商业性无衍生作品许可协议4.0（http://creativecommons.org/licenses/by-nc-nd/4.0/）进行分发。
