Shi Yunhan, Gao Xiang, Liao Jianhong, Li Yanru, Han Demin
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.
Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, People's Republic of China.
Nat Sci Sleep. 2025 Sep 2;17:2065-2078. doi: 10.2147/NSS.S435918. eCollection 2025.
Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, resulting in frequent cortical arousals. However, currently used frequency-based arousal metrics do not sufficiently capture the heterogeneity and clinical significance of arousal responses. The odds ratio product (ORP) is a novel electroencephalographic marker that provides a continuous assessment of sleep depth and has the potential to serve as an objective measure of arousal intensity.
This study aimed to quantify the intensity of arousals in untreated OSA patients using the ORP, and to explore the relationships between arousal intensity, respiratory event features, and subjective sleepiness.
We retrospectively analysed data from 1057 adults with untreated OSA enrolled in the APPLES cohort. EEG spectral power was mapped to ORP values, and arousal intensity for each event was objectively calculated based on deviations in ORP from baseline. A total of 258,121 arousal events were included. Mixed-effects modelling was used to assess the impact of event type, duration, latency, sleep stage, position, and inter-individual variability on arousal intensity. Stepwise multiple regression explored associations between individual arousal intensity and subjective sleepiness.
Arousal intensity increased significantly with the duration of preceding respiratory events, and was markedly higher than that of spontaneous arousals. The association between respiratory events and arousal intensity was stronger for apneas than for hypopneas, while deep sleep stage and lateral posture significantly reduced arousal response. Inter-individual variability was pronounced. Higher baseline arousal intensity was independently associated with increased subjective daytime sleepiness, after adjusting for known confounders.
ORP-derived arousal intensity provides a quantitative biomarker of cortical arousal. Arousal intensity is shaped by respiratory event characteristics, sleep architecture, and intrinsic individual traits. Although slight, arousal intensity is independently associated with subjective daytime sleepiness.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间上呼吸道反复塌陷，导致频繁的皮层觉醒。然而，目前使用的基于频率的觉醒指标未能充分捕捉觉醒反应的异质性和临床意义。优势比乘积（ORP）是一种新型脑电图标记物，可对睡眠深度进行连续评估，并有潜力作为觉醒强度的客观测量指标。
本研究旨在使用ORP量化未经治疗的OSA患者的觉醒强度，并探讨觉醒强度、呼吸事件特征和主观嗜睡之间的关系。
我们回顾性分析了APPLES队列中1057名未经治疗的成年OSA患者的数据。将脑电图频谱功率映射到ORP值，并根据ORP相对于基线的偏差客观计算每个事件的觉醒强度。共纳入258121次觉醒事件。采用混合效应模型评估事件类型、持续时间、潜伏期、睡眠阶段、体位和个体间变异性对觉醒强度的影响。逐步多元回归探讨个体觉醒强度与主观嗜睡之间的关联。
觉醒强度随先前呼吸事件的持续时间显著增加，且明显高于自发觉醒。呼吸事件与觉醒强度之间的关联在呼吸暂停时比在呼吸浅慢时更强，而深睡眠阶段和侧卧位显著降低觉醒反应。个体间变异性明显。在调整已知混杂因素后，较高的基线觉醒强度与主观日间嗜睡增加独立相关。
ORP衍生的觉醒强度提供了皮层觉醒的定量生物标志物。觉醒强度受呼吸事件特征、睡眠结构和个体内在特质的影响。尽管影响轻微，但觉醒强度与主观日间嗜睡独立相关。
