阻塞性睡眠呼吸暂停中问卷定义症状组的临床、多导睡眠图和心理特征

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）具有异质性症状表现，呼吸暂停低通气指数（AHI）无法完全反映这些表现。我们旨在识别OSA患者中四个问卷定义症状组的人口学、多导睡眠图和心理学特征。方法：这项回顾性横断面研究纳入789例未接受过治疗的OSA患者（AHI ≥5次/小时），他们在2021年5月至2025年8月期间接受了整夜多导睡眠监测和神经心理评估。使用匹兹堡睡眠质量指数和Epworth嗜睡量表，将参与者分为四个症状组：低症状负担、仅睡眠质量差、仅日间过度嗜睡（EDS）以及睡眠质量差合并EDS。采用多项logistic回归识别与这些症状组相关的因素，以低症状负担组为参照。结果：结果显示，仅睡眠质量差症状组最为常见（49.0%），其次是低症状负担组（29.8%）、合并组（14.3%）和仅EDS组（6.8%）。女性、较低BMI、睡眠连续性和睡眠阶段分布改变与仅睡眠质量差组相关，而较年轻年龄、较短入睡潜伏期和较短最大低通气持续时间与仅EDS组相关。较高的PHQ-9和CFS评分与所有三个较高症状负担组一致相关（均P < 0.001），其中合并组的效应估计值最大。较高的GAD-7评分也与仅睡眠质量差组和合并组相关，而GAD-7评分与仅EDS组之间的关联较不精确且仅名义显著。若干其他睡眠阶段、阶段或体位特异性呼吸以及肢体运动关联为名义显著，应视为产生假设。若干常规低氧血症指标，包括TST90、平均氧饱和度下降和平均夜间血氧饱和度，在主要校正分析中与任何症状组均无显著关联。总体模式在敏感性分析中大致相似，尽管若干名义关联被减弱。结论：总体而言，问卷定义的OSA症状组在人口学、多导睡眠图和心理学特征方面存在差异，这些差异不能仅由AHI完全反映，支持多维度临床评估，同时需要考虑独立验证的必要性。

英文摘要

Obstructive sleep apnea (OSA) has heterogeneous symptom presentations that are not fully captured by the apnea-hypopnea index (AHI). We aimed to identify demographic, polysomnographic, and psychological profiles across four questionnaire-defined symptom groups in OSA patients. This retrospective cross-sectional study included 789 treatment-naïve patients with OSA (AHI ≥5 events/h) who underwent overnight polysomnography and neuropsychological assessment between May 2021 and August 2025. Participants were classified into four symptom-groups: low symptom burden, poor sleep quality only, excessive daytime sleepiness (EDS) only, and combined poor sleep quality and EDS, using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Multinomial logistic regression was used to identify factors associated with these symptom-groups, with the low symptom burden group as the reference. Results showed that the poor sleep quality only symptom-group was most prevalent (49.0%), followed by the low symptom burden group (29.8%), the combined group (14.3%), and the EDS-only group (6.8%). Female sex, lower BMI, altered sleep continuity and sleep-stage distribution were associated with the poor sleep quality only group, whereas younger age, shorter sleep onset latency and a shorter maximum hypopnea duration were associated with the EDS-only group. Higher PHQ-9 and CFS scores were consistently associated with all three higher symptom-burden groups (all P < 0.001), with the largest effect estimates observed for the combined group. Higher GAD-7 scores were also associated with the poor sleep quality only and combined groups, whereas the association between GAD-7 score and the EDS-only group was less precise and only nominally significant. Several additional sleep-stage, stage- or position-specific respiratory, and limb-movement associations were nominal and should be considered hypothesis-generating. Several conventional hypoxemia measures, including TST90, mean oxygen desaturation, and mean nocturnal oxygen saturation, were not significantly associated with any symptom-group in the primary adjusted analyses. The overall pattern was generally similar in the sensitivity analyses, although several nominal associations were attenuated. Overall, questionnaire-defined OSA symptom groups differed in demographic, polysomnographic, and psychological characteristics that were not fully captured by AHI alone, supporting multidimensional clinical assessment while considering the need for independent validation.