Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep-disordered Breathing.
Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep-disordered Breathing.
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DOI：
10.1164/rccm.202011-4055oc
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发表时间：
2021-12-15
影响因子：
24.7
通讯作者：
Rapoport DM
中科院分区：
文献类型：
--
作者：
Parekh A;Tolbert TM;Mooney AM;Ramos-Cejudo J;Osorio RS;Treml M;Herkenrath SD;Randerath WJ;Ayappa I;Rapoport DM
确定个体是否患有阻塞性或中枢性睡眠呼吸暂停是选择适当治疗的基础。在这里，我们得出了一个自动呼吸阻塞概率，作为黄金标准上呼吸道阻力的替代品，使用临床睡眠研究中可见的上呼吸道阻塞标志。从5个夜间多导睡眠图信号（气流、胸腹用力、血氧饱和度和打鼾）中提取9个特征并进行加权，得出呼吸阻塞概率（Pobs）。29名受试者（开发= 6，测试= 23）（纽约，NY）和39名受试者（索林根，德国）的开发和初始测试组均采用食管测压法，用于开发pob并验证其对金标准上呼吸道阻力的影响。一个单独的数据集，114名受试者连续2次夜间多导睡眠图（纽约，纽约），没有食道测压，用于评估pob的夜间变异性。共分析了1962229次呼吸。在逐呼吸水平上，两组测试中Pobs与归一化上呼吸道阻力密切相关（组1：立方调整[adj.] R2 = 0.87, P < 0.001，受试者工作特征曲线下面积= 0.74；组2：立方调整[adj.] R2 = 0.83, P < 0.001，受试者工作特征曲线下面积= 0.7）。在受试者水平上，中位pob与中位标准化上呼吸道阻力相关（集合1：线性adj = 0.59, P < 0.001；集合2：线性adj = 0.45, P < 0.001）。中位pob表现出较低的夜间变异性[类内相关性(2,1)= 0.93]。利用182名受试者的近200万次呼吸，我们发现呼吸阻塞的概率可以可靠地预测个体受试者呼吸阻塞的总体负担，并有助于确定睡眠呼吸暂停的类型。
Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (Pobs). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop Pobs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of Pobs. A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, Pobs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median Pobs was associated with the median normalized upper airway resistance (set 1: linear adj. R2 = 0.59, P < 0.001; set 2: linear adj. R2 = 0.45, P < 0.001). Median Pobs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.