药物诱导睡眠内镜定义的上气道塌陷表型与成人阻塞性睡眠呼吸暂停患者心脏代谢共病的存在：一项单中心回顾性横断面研究

文献信息

中文摘要

目的： 评估在药物诱导睡眠内镜检查中记录的上气道塌陷表型是否与经多导睡眠图确诊的成人阻塞性睡眠呼吸暂停患者存在心脏代谢共病相关。
方法： 这项单中心回顾性横断面研究分析了来自355名成人的360份药物诱导睡眠内镜评估记录。主要结局为至少一项记录在案的高血压、糖尿病、冠状动脉疾病或脑血管疾病诊断。基线仰卧位软腭-口咽-舌根-会厌严重程度编码为0、1或2级；部位水平塌陷定义为≥1级。逻辑回归对年龄、性别、体重指数、呼吸暂停低通气指数、所有软腭-口咽-舌根-会厌部位以及完全同心性软腭塌陷进行了校正。敏感性分析考察了严重程度、模式、重复标识符、多重性、模型拟合及增量价值。
结果： 156/360份记录（43.3%）存在心脏代谢共病。会厌塌陷在有共病者中比无共病者少见（17.3% vs. 29.4%）。在主模型中，会厌塌陷显示出名义上的反向关联（校正比值比 = 0.55；95%置信区间：0.32-0.95；p = 0.031），但在校正后的药物诱导睡眠内镜预测因素中，Holm校正后p值为0.153。在探索性敏感性分析中，完全性而非部分性会厌塌陷显示出较低的估计比值比（完全性 vs. 无：校正比值比 = 0.42；95%置信区间：0.22-0.80；p = 0.008）。临床模型的受试者工作特征曲线下面积为0.675，加入药物诱导睡眠内镜变量后为0.694；似然比检验不显著（p = 0.203）。
结论： 会厌塌陷与记录在案的心脏代谢共病显示出探索性的反向横断面关联。该关联在多重性校正后不再显著，不应被解释为保护性、时间性或预测性。需要进行方案化的前瞻性验证。

英文摘要

ObjectiveTo evaluate whether upper-airway collapse phenotypes recorded during drug-induced sleep endoscopy were associated with the presence of cardiometabolic comorbidity in adults with polysomnography-confirmed obstructive sleep apnea.MethodsThis single-center retrospective cross-sectional study analyzed 360 drug-induced sleep endoscopy evaluation records from 355 adults. The primary outcome was at least one documented diagnosis of hypertension, diabetes mellitus, coronary artery disease, or cerebrovascular disease. Baseline supine velum-oropharynx-tongue base-epiglottis severity was coded as grade 0, 1, or 2; site-level collapse was defined as grade ≥1. Logistic regression was adjusted for age, sex, body mass index, apnea-hypopnea index, all velum-oropharynx-tongue base-epiglottis sites, and complete concentric velum collapse. Sensitivity analyses examined severity, pattern, repeated identifiers, multiplicity, model fit, and incremental value.ResultsCardiometabolic comorbidity was present in 156/360 records (43.3%). Epiglottic collapse was less frequent with than without comorbidity (17.3% vs. 29.4%). In the primary model, epiglottic collapse showed a nominal inverse association (adjusted odds ratio = 0.55; 95% confidence interval: 0.32-0.95; p = 0.031), but the Holm-adjusted p value across adjusted drug-induced sleep endoscopy predictors was 0.153. In exploratory sensitivity analyses, complete, but not partial, epiglottic collapse showed lower estimated odds (complete vs. none: adjusted odds ratio = 0.42; 95% confidence interval: 0.22-0.80; p = 0.008). The clinical model area under the receiver operating characteristic curve was 0.675 vs. 0.694 after adding drug-induced sleep endoscopy variables; the likelihood-ratio test was not significant (p = 0.203).ConclusionsEpiglottic collapse showed an exploratory inverse cross-sectional association with documented cardiometabolic comorbidity. The association did not remain significant after multiplicity correction and should not be interpreted as protective, temporal, or predictive. Protocolized prospective validation is required.