Wang Donghao, Zhang Yuting, Gan Qiming, Su Xiaofen, Chen Yating, Zhang Haojie, Zhou Yanyan, Zhuang Zhiyang, Wang Jingcun, Ding Yutong, Zhao Dongxing, Zhang Nuofu
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People's Republic of China.
The Clinical Medicine Department, Henan University, Zhengzhou, People's Republic of China.
Nat Sci Sleep. 2025 Aug 27;17:1945-1956. doi: 10.2147/NSS.S551944. eCollection 2025.
A low arousal threshold (AT) appears to contribute to obstructive sleep apnea (OSA) pathogenesis. However, the role of low AT in OSA and overlap syndrome (OVS) is still unclear. This study is aimed to investigate the value of the AT score, a new method for qualifying AT, for examining the relationship between OSA and OVS, including chronic obstructive pulmonary disease (COPD) and asthma.
In this retrospective study, a total of 3400 adults diagnosed with OSA at a sleep medicine center were finally included. All patients were stratified into low-, high- and very high-AT score groups according to the previous logistic regression for qualifying AT. Multivariate logistic regression was conducted to evaluate the association between AT score and OVS prevalence. We compared this association with that of the apnea hypopnea index (AHI).
40.3%, 42.9% and 16.8% of OSA patients had low-, high- and very high AT score, respectively. Compared with the very high AT score, the low AT score was independently associated with the prevalence of COPD (OR = 2.17, 95% CI = 1.09-4.32) and asthma (OR = 4.54, 95% CI = 2.52-8.17). With decreasing AT score, the adjusted ORs of the comorbidities increased stepwise, particularly in some subgroups based on sex, age and BMI. Conversely, the classification of AHI did not show similar values.
In individuals with OSA, low AT is a common pathophysiological feature associated with COPD and asthma. The AT score is a new and effective indicator for evaluating the relationship between OSA and OVS.
低唤醒阈值（AT）似乎在阻塞性睡眠呼吸暂停（OSA）发病机制中起作用。然而，低AT在OSA和重叠综合征（OVS）中的作用仍不清楚。本研究旨在探讨AT评分（一种用于量化AT的新方法）在研究OSA与OVS（包括慢性阻塞性肺疾病（COPD）和哮喘）之间关系方面的价值。
在这项回顾性研究中，最终纳入了在一家睡眠医学中心诊断为OSA的3400名成年人。根据先前用于量化AT的逻辑回归，将所有患者分为低、高和非常高AT评分组。进行多变量逻辑回归以评估AT评分与OVS患病率之间的关联。我们将这种关联与呼吸暂停低通气指数（AHI）的关联进行了比较。
OSA患者中，低、高和非常高AT评分的比例分别为40.3%、42.9%和16.8%。与非常高AT评分相比，低AT评分与COPD患病率（OR = 2.17，95%CI = 1.09 - 4.32）和哮喘患病率（OR = 4.54，95%CI = 2.52 - 8.17）独立相关。随着AT评分降低，合并症的调整后OR值逐步增加，特别是在基于性别、年龄和BMI的一些亚组中。相反，AHI的分类未显示出类似的值。
在OSA患者中，低AT是与COPD和哮喘相关的常见病理生理特征。AT评分是评估OSA与OVS之间关系的一种新的有效指标。
