Wang Yuhan, Yue Wuriliga, Zhou Beini, Zhang Jingyi, He Yang, Wang Mengcan, Hu Ke
Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
Nat Sci Sleep. 2025 May 29;17:1101-1112. doi: 10.2147/NSS.S505702. eCollection 2025.
The apnea-hypopnea index (AHI) has limitations in assessing nocturnal hypoxemia and excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) patients. This study evaluated whether hourly apnea-hypopnea duration (HAD) and mean apnea-hypopnea duration (MAD) could complement or outperform AHI.
This study included 1069 OSA patients, of whom 754 completed the Epworth Sleepiness Scale (ESS). Multivariable regression models evaluated the associations between AHI, MAD, HAD, and nocturnal hypoxemia, and standardized scores were used for comparison. The predictive ability of AHI, MAD, and HAD models for EDS was evaluated using goodness-of-fit indices, and receiver operating characteristic (ROC) curve analysis was performed using bootstrapping techniques.
Nocturnal hypoxemia was observed in 317 participants (29.65%). Patients with nocturnal hypoxemia had significantly higher AHI (43.19 ± 18.41 vs 21.78 ± 14.73 events/hour, P < 0.001) and longer HAD (16.71 ± 7.48 vs 8.24 ± 5.40 minutes, P < 0.001). After adjusting for age, sex, and BMI, AHI and HAD were still significantly associated with nocturnal hypoxemia (P < 0.05). Standardized scores analysis revealed that HAD had the strongest association with nocturnal hypoxemia (HAD: OR = 3.69, 95% CI: 3.06-4.46, P < 0.0001; AHI: OR = 3.48, 95% CI: 2.90-4.18, P < 0.0001; MAD: OR = 1.01, 95% CI: 0.88-1.15, P = 0.9314) and mean SpO (HAD: β = -0.91, 95% CI: -1.02--0.79, P < 0.0001; AHI: β = -0.85, 95% CI: -0.97--0.74, P < 0.0001; MAD: β = 0.00, 95% CI: -0.12-0.12, P = 0.9595), outperforming AHI and MAD. The HAD model showed the best fit for predicting EDS, with an area under the curve of 0.61 at a threshold of 5.63.
The HAD better correlates with OSA-related nocturnal hypoxemia and EDS rather than AHI. The duration of respiratory events warrants more investigation in clinical assessment.
呼吸暂停低通气指数（AHI）在评估阻塞性睡眠呼吸暂停（OSA）患者的夜间低氧血症和日间过度嗜睡（EDS）方面存在局限性。本研究评估了每小时呼吸暂停低通气持续时间（HAD）和平均呼吸暂停低通气持续时间（MAD）是否可以补充或优于AHI。
本研究纳入了1069例OSA患者，其中754例完成了爱泼华嗜睡量表（ESS）。多变量回归模型评估了AHI、MAD、HAD与夜间低氧血症之间的关联，并使用标准化分数进行比较。使用拟合优度指数评估AHI、MAD和HAD模型对EDS的预测能力，并使用自抽样技术进行受试者操作特征（ROC）曲线分析。
317名参与者（29.65%）观察到夜间低氧血症。夜间低氧血症患者的AHI显著更高（43.19±18.41比21.78±14.73次/小时，P<0.001），HAD更长（16.71±7.48比8.24±5.40分钟，P<0.001）。在调整年龄、性别和BMI后，AHI和HAD仍与夜间低氧血症显著相关（P<0.05）。标准化分数分析显示，HAD与夜间低氧血症的关联最强（HAD：OR=3.69，95%CI：3.06-4.46，P<0.0001；AHI：OR=3.48，95%CI：2.90-4.18，P<0.0001；MAD：OR=1.01，95%CI：0.88-1.15，P=0.9314）和平均SpO（HAD：β=-0.91，95%CI：-1.02--0.79，P<0.0001；AHI：β=-0.85，95%CI：-0.97--0.74，P<0.0001；MAD：β=0.00，95%CI：-0.12-0.12，P=0.9595），优于AHI和MAD。HAD模型对EDS的预测拟合度最佳，阈值为5.63时曲线下面积为0.61。
HAD与OSA相关的夜间低氧血症和EDS的相关性优于AHI。呼吸事件的持续时间在临床评估中值得进一步研究。
