超越单一缺氧负荷值：通过外周动脉张力测定评估阻塞性睡眠呼吸暂停中的缺氧负荷比值

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中文摘要

目的： 缺氧负荷（HB）综合了阻塞性睡眠呼吸暂停（OSA）夜间氧饱和度下降的深度和持续时间，但单一HB值可能掩盖不同的低氧血症特征。我们探讨了源自外周动脉张力测定家庭睡眠呼吸暂停检测（PAT-HSAT）数据的两种自动HB指标之间的关系：SpO2基线以下去饱和面积（HB_baseline）和90% SpO2以下面积（HB_<90%）。
方法： 我们进行了一项回顾性横断面研究，纳入2136例成人OSA患者，依据基于3%去饱和标准的外周动脉张力测定衍生的呼吸暂停低通气指数（pAHI3%）≥5次/小时诊断。根据HB_baseline与HB_<90%之间的关系设定三个操作性HB组。1型特征为可测量的HB_baseline（>0%·min/h）且HB_<90% = 0%·min/h；由于分母为零，HB_baseline/HB_<90%比值无法计算。在HB_<90%可测量的患者中，2型定义为HB比值≥1，3型定义为HB比值<1。这三个组被预先设定为探索性操作分类。
结果： 1型、2型和3型分别包括506例（23.7%）、1108例（51.9%）和522例（24.4%）患者。SpO2低于90%的总睡眠时间（TST）百分比（T90）在1型、2型和3型中的中位值分别为0.1%、5.4%和63.6%。2型和3型的中位pAHI3%相似（26.3和28.8次/小时），但中位HB_<90%差异显著（6.0和86.5%·min/h）。HB_baseline在所有组中与pAHI3%强相关（Spearman ρ，0.9295-0.9378），而HB_<90%在2型和3型中与pAHI3%中度相关（ρ=0.6292和0.6209；均P<0.001）。
结论： HB_baseline与HB_<90%的相对大小提供了一个探索性操作框架，用于描述OSA中超越单一HB值的不同低氧血症特征。该框架为描述性和假设生成性；其临床、预后、机制和治疗效用尚未确立，需要外部和纵向验证。

英文摘要

PURPOSE: Hypoxic burden (HB) integrates the depth and duration of nocturnal oxygen desaturation in obstructive sleep apnea (OSA), but a single HB value may conceal distinct hypoxemic profiles. We explored the relationship between two automated HB measures derived from peripheral arterial tonometry-based home sleep apnea testing (PAT-HSAT) data: desaturation area under the SpO2 baseline (HB_baseline) and area under 90% SpO2 (HB_<90%).
METHODS: We performed a retrospective cross-sectional study of 2136 adults with OSA, diagnosed by a peripheral arterial tonometry-derived apnea-hypopnea index based on 3% desaturation criteria (pAHI3%) ≥5 events/h. Three operational HB groups were designated according to the relationship between HB_baseline and HB_<90%. Type 1 was characterized by measurable HB_baseline (>0%·min/h) and HB_<90% = 0%·min/h; the HB_baseline/HB_<90% ratio was not calculable because the denominator was zero. Among patients with measurable HB_<90%, Type 2 was defined by an HB ratio ≥1 and Type 3 by an HB ratio <1. These three groups were prespecified as exploratory operational categories.
RESULTS: Type 1, Type 2, and Type 3 comprised 506 (23.7%), 1108 (51.9%), and 522 (24.4%) patients, respectively. The percentage of total sleep time (TST) with SpO2 below 90% (T90) had median values of 0.1%, 5.4%, and 63.6% in Types 1, 2, and 3, respectively. Types 2 and 3 had similar median pAHI3% (26.3 and 28.8 events/h) but markedly different median HB_<90% (6.0 and 86.5%·min/h). HB_baseline correlated strongly with pAHI3% across all groups (Spearman ρ, 0.9295-0.9378), whereas HB_<90% correlated moderately with pAHI3% in Types 2 and 3 (ρ=0.6292 and 0.6209; all P<0.001).
CONCLUSION: The relative magnitude of HB_baseline and HB_<90% provides an exploratory operational framework for describing distinct hypoxemic profiles in OSA beyond a single HB value. The framework is descriptive and hypothesis-generating; its clinical, prognostic, mechanistic, and therapeutic utility has not been established and requires external and longitudinal validation.