低通气为主型OSA的内型特征：低通气标准的作用

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中文摘要

背景： 低通气为主型OSA（HypoOSA）与呼吸暂停为主型OSA相比代表一种不同的表型。然而，低通气一直使用不同的标准定义，导致AHI估计的差异。本研究探讨了根据低通气≥4%血氧饱和度下降（4% OD）和≥3%血氧饱和度下降或觉醒（3% ODA）标准定义的HypoOSA的内型特征，以及AHI和内型特征如何因标准而异。方法：我们前瞻性招募了来自单一睡眠中心的765名中重度OSA成年患者。内型特征来自实验室多导睡眠监测研究。呼吸事件使用3% ODA和4% OD标准分别评分两次。识别了以AHI中呼吸暂停<50%定义的HypoOSA的内型特征，并与呼吸暂停为主型OSA进行比较。分析了低通气标准之间内型特征的受试者内差异。结果：我们观察到4% OD和3% ODA分别将40.3%和57.0%的患者识别为HypoOSA。与呼吸暂停为主型OSA相比，无论使用何种低通气标准，HypoOSA的特征是较低的觉醒阈值、较高的补偿和较少塌陷的上气道。与4% OD标准相比，3% ODA低通气标准使AHI增加33%，而SpO2<90%的时间比例和内型特征变化较小。两种标准之间AHI估计一致性低的患者与高一致性组相比，AHI较低且上气道病理有利。结论：HypoOSA的特征是较低的觉醒阈值和有利的上气道通畅性。不同的低通气标准导致AHI变化，尤其是在AHI较低的患者中，而缺氧负担和内型特征保持相对稳定。

英文摘要

Hypopnea-predominant OSA (HypoOSA) represents a distinct phenotype compared to apnea-predominant OSA. Nevertheless, hypopnea has been defined using varying criteria, leading to differences in the estimation of AHI. This study investigated the endotypic traits of HypoOSA, as defined by ≥ 4% desaturation (4% OD) and ≥ 3% desaturation or arousal (3% ODA) criteria for hypopnea and how AHI and endotypic traits differ by criteria. We prospectively enrolled 765 adult patients with moderate-to-severe OSA from a single sleep centre. Endotypic traits were obtained from in-laboratory polysomnographic studies. Respiratory events were scored twice using 3% ODA and 4% OD criteria. Endotypic traits characterizing HypoOSA, defined as AHI comprising < 50% apneas, were identified and compared to apnea-predominant OSA. Within-subject differences in endotypic traits between the hypopnea criteria were analysed. We observed that 4% OD and 3% ODA identified 40.3% and 57.0% patients as HypoOSA, respectively. Compared to apnea-predominant OSA, HypoOSA was characterized by a lower arousal threshold, higher compensation and less collapsible upper airway, regardless of hypopnea criteria used. Compared with the 4% OD criterion, the 3% ODA criterion for hypopnea increased AHI by 33%, whereas the proportion of time with SpO2 < 90% and endotypic traits showed less variation. Patients with low consistency in AHI estimates between the two criteria showed lower AHI and favourable upper airway pathology compared to the high consistency group. In conclusion, HypoOSA is characterized by lower arousal threshold and favourable upper airway patency. Different hypopnea criteria resulted in variation in AHI, particularly among patients with lower AHI, whereas hypoxic burden and endotypic traits remained relatively stable.