Landolfo Matteo, Giulietti Federico, Spannella Francesco, Sarnari Silvia, Di Pentima Chiara, Giordano Piero, Sarzani Riccardo
Department of Clinical and Molecular Sciences, Centre of Obesity, "Politecnica delle Marche" University, Ancona, Italy.
Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy.
ERJ Open Res. 2025 Jun 2;11(3). doi: 10.1183/23120541.00705-2024. eCollection 2025 May.
Obstructive sleep apnoea (OSA) is linked to cardiovascular disease (CVD). The obstructive apnoea-hypopnoea index (oAHI) used for diagnosing and grading OSA has limitations in predicting CVD. The present study assessed and compared the association between nocturnal hypoxaemia parameters and left ventricular hypertrophy (LVH).
A cross-sectional study was conducted on 187 consecutive adult outpatients diagnosed with OSA after home cardiorespiratory polygraphy. Blood pressure control was tested with ambulatory blood pressure monitoring. A standard transthoracic cardiac ultrasound examination assessed LVH. Oximetry parameters were grouped into a single parameter (Oxy-score) using factor analysis (a higher Oxy-score indicating better nocturnal oxygenation), which was tested for association with LVH.
The mean age was 60±12 years, with 75% male sex and 94% overweight/obese. The prevalence of arterial hypertension and LVH was 92% and 75%, respectively. The prevalence of severe OSA was 44%, with a mean oAHI of 32±19. Patients with LVH had significantly higher oAHI (34±19 27±18; p=0.030), oxygen desaturation index (41±23 30±18; p=0.004), and worse oximetry parameters. Oxy-score results were independently associated with LVH (adjusted OR 0.45; p=0.044). oAHI lost its independent relationship with LVH when the model included the Oxy-score. Receiver operating characteristic curves showed that oAHI was less accurate in predicting LVH than Oxy-score (area under the curve (AUC) 0.63, 95% CI 0.59-0.68 AUC 0.70, 95% CI 0.65-0.74, respectively; p=0.005).
Nocturnal oximetry parameters, grouped into a single parameter as a proxy of the global hypoxic burden, proved to be a better and independent predictor of LVH than oAHI, supporting the pivotal relevance of oximetry parameters beyond oAHI in patients with OSA.
阻塞性睡眠呼吸暂停（OSA）与心血管疾病（CVD）相关。用于诊断和分级OSA的阻塞性呼吸暂停低通气指数（oAHI）在预测CVD方面存在局限性。本研究评估并比较了夜间低氧血症参数与左心室肥厚（LVH）之间的关联。
对187例经家庭心肺多导睡眠监测诊断为OSA的成年门诊患者进行了一项横断面研究。采用动态血压监测来检测血压控制情况。通过标准的经胸心脏超声检查评估LVH。使用因子分析将血氧饱和度参数分组为单一参数（Oxy评分，Oxy评分越高表明夜间氧合越好），并测试其与LVH的关联。
平均年龄为60±12岁，男性占75%，超重/肥胖者占94%。动脉高血压和LVH的患病率分别为92%和75%。重度OSA的患病率为44%，平均oAHI为32±19。LVH患者的oAHI（34±19对27±18；p = 0.030）、氧饱和度下降指数（41±23对30±18；p = 0.004）显著更高，且血氧饱和度参数更差。Oxy评分结果与LVH独立相关（调整后的OR为0.45；p = 0.044）。当模型纳入Oxy评分时，oAHI与LVH失去了独立关系。受试者工作特征曲线显示，oAHI在预测LVH方面不如Oxy评分准确（曲线下面积（AUC）分别为0.63，95%CI 0.59 - 0.68对0.70，95%CI 0.65 - 0.74；p = 0.005）。
夜间血氧饱和度参数作为整体低氧负担的单一参数，被证明是比oAHI更好的LVH独立预测指标，这支持了在OSA患者中，除oAHI外血氧饱和度参数的关键相关性。
