Bennett L S, Langford B A, Stradling J R, Davies R J
The Osler Chest Unit, Churchill Hospital, Headington, Oxford, United Kingdom.
Am J Respir Crit Care Med. 1998 Sep;158(3):778-86. doi: 10.1164/ajrccm.158.3.9711033.
Sleep fragmentation and respiratory disturbance measures are used in the assessment of obstructive sleep apnea (OSA) but have proved to be disappointingly poor correlates of daytime sleepiness. This study investigates the ability of electroencephalograph (EEG) and non-EEG sleep fragmentation indices to predict both presenting sleepiness and the improvement in sleepiness with subsequent nasal continuous positive airway pressure (nCPAP) therapy (nCPAP responsive sleepiness). Forty-one patients (36 men, 5 women), ranging from nonsnorers to severe OSA (> 4% O2 dip rate, median 11.1, range 0.4 to 76.5), had polysomnography with microarousal scoring, computerized EEG analysis, autonomic arousal detection, and body movement analysis. All patients received a trial of nCPAP regardless of sleep study outcome. Spearman's correlation analysis showed significant and similar associations between all sleep fragmentation indices with both pretreatment and nCPAP responsive sleepiness. There was no deterioration in sleepiness on nCPAP in the nonsnorers. Using stepwise multiple regression analysis, the best predictor of nCPAP responsive subjective and objective sleepiness was body movement index, explaining 38% and 43% of the variance, respectively. Variability in EEG sleep depth, quantified from computerized EEG analysis, was the only other index to contribute to these models. Together these indices explained 44% and 51% of the subjective and objective response to nCPAP, respectively. These results suggest that sleep fragmentation indices are useful for identifying OSA patients with sleepiness likely to respond to nCPAP.
睡眠片段化和呼吸紊乱指标用于阻塞性睡眠呼吸暂停（OSA）的评估，但事实证明，它们与日间嗜睡的相关性差得令人失望。本研究调查了脑电图（EEG）和非EEG睡眠片段化指标预测当前嗜睡情况以及随后经鼻持续气道正压通气（nCPAP）治疗后嗜睡改善情况（nCPAP反应性嗜睡）的能力。41例患者（36例男性，5例女性），从非打鼾者到重度OSA患者（氧饱和度下降率>4%，中位数11.1，范围0.4至76.5），进行了多导睡眠图检查，包括微觉醒评分、计算机化脑电图分析、自主神经觉醒检测和身体运动分析。所有患者无论睡眠研究结果如何，均接受nCPAP试验。Spearman相关性分析显示，所有睡眠片段化指标与治疗前嗜睡和nCPAP反应性嗜睡之间均存在显著且相似的关联。非打鼾者使用nCPAP后嗜睡情况没有恶化。采用逐步多元回归分析，nCPAP反应性主观和客观嗜睡的最佳预测指标是身体运动指数，分别解释了38%和43%的方差。从计算机化脑电图分析中量化的脑电图睡眠深度变异性是唯一对这些模型有贡献的其他指标。这些指标共同分别解释了对nCPAP主观和客观反应的44%和51%。这些结果表明，睡眠片段化指标有助于识别可能对nCPAP有反应的嗜睡OSA患者。
