Gao Xiang, Shi Yunhan, Sui Rongcui, Xu Shenglong, Xu Mengyu, Liao Jianhong, Li Yanru, Han Demin
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, PR China; Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, PR China; Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, PR China.
Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China.
Sleep Med. 2025 Sep;133:106642. doi: 10.1016/j.sleep.2025.106642. Epub 2025 Jun 17.
Obstructive sleep apnea (OSA) disrupts sleep, leading to cognitive impairment and sleepiness, but risk stratification remains unclear. We developed an EEG-based arousal marker to quantify sleep fragmentation and assessed its associations with neurocognitive function and daytime sleepiness.
Arousal intensity was derived from EEG signals in 1070 APPLES (Apnea Positive Pressure Long-term Efficacy Study) study participants. We analyzed its associations with PSG parameters, cognitive function (Wechsler Abbreviated Scale of Intelligence, WASI), and sleepiness (Multiple Sleep Latency Test, MSLT; Epworth Sleepiness Scale, ESS). Stepwise regression identified predictors of cognitive function. Sensitivity analysis examined arousal intensity's link to 6-month CPAP outcomes (N = 419).
Among OSA individuals, the AHI ranged from 10 to 130.7/h, the average arousal index was 26.75/h and a total of 235,835 arousal events were extracted. The arousal intensity was significantly greater for hypoxia-associated and desaturation-related events compared to hypopnea-associated or spontaneous arousals (p<0.001). It correlated negatively with age, PSG measures, and cognitive function. Adjusted models showed Delta-band arousal intensity negatively predicted WASI-Full scores (β = -3.24, p = 0.019). Higher Gamma-band intensity was associated with both greater subjective sleepiness (ESS: β = 0.03, p = 0.028) and increased CPAP-induced MSLT improvement (β = 0.12, p = 0.020).
Arousal intensity is a novel EEG marker for cognitive impairment and sleepiness in OSA, with potential clinical utility in predicting CPAP response. This EEG-based marker could be integrated into standard sleep analysis platforms to identify OSA patients at risk of cognitive impairment, enabling early intervention.
阻塞性睡眠呼吸暂停（OSA）会扰乱睡眠，导致认知障碍和嗜睡，但风险分层仍不明确。我们开发了一种基于脑电图的觉醒标志物来量化睡眠碎片化，并评估其与神经认知功能和日间嗜睡的关联。
从1070名APPLES（呼吸暂停正压长期疗效研究）研究参与者的脑电图信号中得出觉醒强度。我们分析了其与多导睡眠图（PSG）参数、认知功能（韦氏简版智力量表，WASI）和嗜睡（多次睡眠潜伏期试验，MSLT；爱泼华嗜睡量表，ESS）的关联。逐步回归确定了认知功能的预测因素。敏感性分析检验了觉醒强度与6个月持续气道正压通气（CPAP）结果的联系（N = 419）。
在OSA个体中，呼吸暂停低通气指数（AHI）范围为10至130.7次/小时，平均觉醒指数为26.75次/小时，共提取了235,835次觉醒事件。与呼吸浅慢相关或自发觉醒相比，与缺氧相关和去饱和相关事件的觉醒强度明显更大（p<0.001）。它与年龄、PSG测量值和认知功能呈负相关。调整后的模型显示，δ波段觉醒强度对WASI全量表得分有负向预测作用（β = -3.24，p = 0.019）。较高的γ波段强度与更高的主观嗜睡程度（ESS：β = 0.03，p = 0.02）和CPAP诱导的MSLT改善增加有关（β = 0.12，p = 0.02）。
觉醒强度是OSA中认知障碍和嗜睡的一种新型脑电图标志物，在预测CPAP反应方面具有潜在的临床应用价值。这种基于脑电图的标志物可整合到标准睡眠分析平台中，以识别有认知障碍风险的OSA患者，从而实现早期干预。
