呼吸-缺氧负荷与多病共存相关脆弱性是阻塞性睡眠呼吸暂停的不同维度：一项回顾性队列分析
Respiratory-hypoxic burden and multimorbidity-related vulnerability are distinct dimensions of obstructive sleep apnea: A retrospective cohort analysis.
文献信息
| PMID | 42810912 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Giada Gironda |
| 作者单位 | Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. Electronic address: giada-gi@live.it. |
| 期刊 | European journal of internal medicine |
| SCI 分区 | Q1 |
| IF | 6.9 |
| 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）是一种异质性疾病，传统的基于呼吸暂停低通气指数（AHI）的严重程度分类不能完全反映呼吸负荷、夜间低氧血症、肥胖和多病共存。OSA严重程度是否沿不同的呼吸和多病共存相关维度组织尚不清楚。
目的： 确定OSA严重程度是否沿不同的呼吸-缺氧和多病共存相关维度组织，以及这些维度是否定义了具有临床意义的患者表型。
方法： 我们回顾性分析了306名未经治疗的OSA成人前瞻性收集的数据。评估了人口统计学、人体测量学、呼吸描记法、血氧测定、日间嗜睡和累积疾病评定量表（CIRS）衍生的指标。主成分分析（PCA）识别潜在严重程度维度，随后进行层次聚类和k均值聚类以推导临床表型。
结果： PCA识别出两个部分分离的维度，解释了总方差的57.4%：一个以AHI、夜间低氧血症和肥胖为特征的呼吸-缺氧负荷维度，以及一个以年龄和CIRS衍生指标为特征的年龄和多病共存相关脆弱性维度。出现了四种临床不同的表型：老年多病共存型（n=101）、缺氧代谢型（n=65）、年轻保留型（n=92）和严重肥胖缺氧型（n=48）。多病共存相关脆弱性与传统呼吸严重程度指标仅显示弱相关性。
结论： OSA严重程度似乎沿互补的呼吸-缺氧和多病共存相关维度组织。这种多维框架提供了一种临床可解释的方法，以理解超出传统呼吸严重程度指标的患者异质性。
英文摘要
BACKGROUND: Obstructive sleep apnea (OSA) is a heterogeneous disorder in which conventional apnea-hypopnea index (AHI)-based severity classification incompletely captures respiratory burden, nocturnal hypoxemia, obesity, and multimorbidity. Whether OSA severity is organized along distinct respiratory and multimorbidity-related dimensions remains unclear.
OBJECTIVES: To determine whether OSA severity is organized along distinct respiratory-hypoxic and multimorbidity-related dimensions and whether these dimensions define clinically meaningful patient phenotypes.
METHODS: We retrospectively analyzed prospectively collected data from 306 untreated adults with OSA. Demographic, anthropometric, respiratory polygraphy, oximetry, daytime sleepiness, and Cumulative Illness Rating Scale (CIRS)-derived measures were assessed. Principal component analysis (PCA) identified latent severity dimensions, followed by hierarchical and k-means clustering to derive clinical phenotypes.
RESULTS: PCA identified two partially dissociated dimensions explaining 57.4% of total variance: a respiratory-hypoxic burden dimension characterized by AHI, nocturnal hypoxemia, and obesity, and an age- and multimorbidity-related vulnerability dimension characterized by age and CIRS-derived measures. Four clinically distinct phenotypes emerged: older-multimorbid (n = 101), hypoxic-metabolic (n = 65), young-preserved (n = 92), and severe obese-hypoxic (n = 48). Multimorbidity-related vulnerability showed only weak correlations with conventional respiratory severity metrics.
CONCLUSION: OSA severity appears to be organized along complementary respiratory-hypoxic and multimorbidity-related dimensions. This multidimensional framework provides a clinically interpretable approach to understanding patient heterogeneity beyond conventional respiratory severity metrics.