阻塞性睡眠呼吸暂停中的额区慢波不对称及其在CPAP滴定期间的调节

文献信息

中文摘要

研究目的： 睡眠慢波活动（SWA）呈现反映局部皮层调节的区域性和半球间差异。阻塞性睡眠呼吸暂停（OSA）引入反复的呼吸不稳定和觉醒，可能改变睡眠期间的皮层动力学。持续气道正压通气（CPAP）是否影响半球间SWA平衡仍不清楚。
方法： 在这项回顾性观察研究中，我们纳入接受诊断性多导睡眠监测、随后在另一晚接受CPAP滴定研究的成年患者。采用频谱分析从F3-A2和F4-A1计算N3期睡眠期间的额区δ功率。半球不对称性采用归一化不对称指数（F4 - F3）/（F4 + F3）量化。睡眠、呼吸和EEG参数采用配对非参数检验进行比较。
结果： 共纳入143例患者（中位年龄47岁，76%为男性）。CPAP改善了呼吸参数，中位呼吸暂停低通气指数从27.4降至3.2次/小时（P < .001）。CPAP期间F3和F4的额区δ功率均下降（P < .001）。绝对不对称指数从9.35%降至7.55%（P = .008）。有符号不对称性向左半球优势偏移（P < .001）。诊断夜以右优势模式更常见，而CPAP期间以左优势模式为主。在两晚均存在非中性不对称的患者中，优势方向发生显著变化（McNemar P = .008），主要从右转为左。
结论： CPAP与深睡眠期间额区δ功率降低及半球间SWA不对称性减弱相关，提示呼吸稳定可能影响皮层组织。解读这些发现时应考虑潜在的夜間间变异。

英文摘要

STUDY OBJECTIVES: Sleep slow-wave activity (SWA) shows regional and hemispheric variation reflecting local cortical regulation. Obstructive sleep apnea (OSA) introduces recurrent respiratory instability and arousals that may alter cortical dynamics during sleep. It remains unclear whether continuous positive airway pressure (CPAP) affects hemispheric SWA balance.
METHODS: In this retrospective observational study, we included adult patients who underwent diagnostic polysomnography followed by a CPAP titration study on a separate night. Frontal delta power during N3 sleep was calculated from F3-A2 and F4-A1 using spectral analysis. Hemispheric asymmetry was quantified using a normalized asymmetry index (F4 - F3) / (F4 + F3). Sleep, respiratory, and EEG parameters were compared using paired nonparametric tests.
RESULTS: A total of 143 patients were included (median age 47 years, 76% male). CPAP improved respiratory parameters, with median apnea-hypopnea index decreasing from 27.4 to 3.2 events/h (P < .001). Frontal delta power decreased at both F3 and F4 during CPAP (P < .001). Absolute asymmetry index decreased from 9.35% to 7.55% (P = .008). Signed asymmetry shifted toward left hemispheric dominance (P < .001). Right-dominant patterns were more frequent during the diagnostic night, whereas left-dominant patterns predominated during CPAP. Among patients with non-neutral asymmetry on both nights, dominance direction changed significantly (McNemar P = .008), mainly from right to left.
CONCLUSION: CPAP is associated with reduced frontal delta power and attenuation of hemispheric SWA asymmetry during deep sleep, suggesting that respiratory stabilization may influence cortical organization. These findings should be interpreted considering potential night-to-night effects.