唾液α-淀粉酶作为阻塞性睡眠呼吸暂停严重程度及持续气道正压通气依从性的生物标志物：一种基于聚类的表型分析方法
Salivary alpha-amylase as a biomarker for obstructive sleep apnea severity and continuous positive airway pressure adherence: A cluster-based phenotyping approach.
文献信息
| PMID | 42810322 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kazuyuki Ohmura |
| 作者单位 | School of Medical Technology, Faculty of Health and Medical Care, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1241, Japan; Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0400, Japan. Electronic address: kohmura@saitama-med.ac.jp. |
| 期刊 | Respiratory investigation |
| SCI 分区 | Q3 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 阻塞性睡眠呼吸暂停（OSA）以反复发生的呼吸暂停事件导致交感神经系统激活为特征。唾液α-淀粉酶（sAA）是一种反映交感神经活动的无创生物标志物；然而，其在OSA中的临床相关性仍未得到充分探索。
方法： 这项前瞻性观察性研究纳入了177名疑似OSA的成人，他们接受了整夜多导睡眠监测和睡前sAA活性测定。鼻阻塞通过主观和客观方法进行评估。在需要持续气道正压通气（CPAP）的患者（n = 104）中，使用sAA活性、呼吸暂停低通气指数（AHI）、睡眠效率（SE）和鼻部参数进行聚类分析。在3个月和6个月时评估CPAP依从性。
结果： 在重度OSA（AHI ≥ 30）患者中观察到更高的sAA活性。sAA活性升高还与较低的SE和更严重的主观鼻阻塞相关。在多变量logistic回归分析中，sAA活性仍与重度OSA显著相关。聚类分析确定了三种表型：（1）低sAA活性伴睡眠保留；（2）高sAA活性伴鼻阻塞；（3）高sAA活性伴重度OSA、高体重指数和低SE。与聚类1相比，聚类2和聚类3在3个月和/或6个月时表现出更低的CPAP依从性。
结论： sAA活性与OSA严重程度、SE降低以及更严重的主观鼻阻塞相关。纳入sAA活性和这些临床特征的表型显示出不同的CPAP依从性模式。这些发现表明，纳入sAA活性的表型分析可能有助于识别有CPAP依从性差风险的患者，并为治疗策略提供信息。
英文摘要
BACKGROUND: Obstructive sleep apnea (OSA) is characterized by repetitive apneic events leading to sympathetic nervous system activation. Salivary alpha-amylase (sAA) is a non-invasive biomarker reflecting sympathetic activity; however, its clinical relevance in OSA remains underexplored.
METHODS: This prospective, observational study included 177 adults with suspected OSA who underwent overnight polysomnography and pre-sleep sAA activity measurement. Nasal obstruction was assessed subjectively and objectively. Cluster analysis was performed using sAA activity, the apnea-hypopnea index (AHI), sleep efficiency (SE), and nasal parameters in patients requiring continuous positive airway pressure (CPAP; n = 104). CPAP adherence was evaluated at 3 and 6 months.
RESULTS: Higher sAA activity was observed in patients with severe OSA (AHI ≥ 30). Elevated sAA activity was also associated with lower SE and greater subjective nasal obstruction. In the multivariate logistic regression analysis, sAA activity remained significantly associated with severe OSA. Cluster analysis identified three phenotypes: (1) low sAA activity with preserved sleep; (2) high sAA activity with nasal obstruction; and (3) high sAA activity with severe OSA, high body mass index, and low SE. Clusters 2 and 3 showed lower CPAP adherence at 3 and/or 6 months than Cluster 1.
CONCLUSION: sAA activity was associated with OSA severity, reduced SE, and greater subjective nasal obstruction. Phenotypes incorporating sAA activity and these clinical characteristics showed different patterns of CPAP adherence. These findings suggest that phenotyping incorporating sAA activity may help identify patients at risk of poor CPAP adherence and inform treatment strategies.