Obstructive Sleep Apnea without Obesity Is Common and Difficult to Treat: Evidence for a Distinct Pathophysiological Phenotype
Obstructive Sleep Apnea without Obesity Is Common and Difficult to Treat: Evidence for a Distinct Pathophysiological Phenotype
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DOI：
10.5664/jcsm.6394
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发表时间：
2017-01-01
影响因子：
4.3
通讯作者：
Eckert, Danny J.
中科院分区：
文献类型：
--
作者：
Gray, Emma L.;McKenzie, David K.;Eckert, Danny J.
研究目的：了解非肥胖阻塞性睡眠呼吸暂停（OSA）患者的比例、生理特征及其对处方治疗的反应。方法：对163名因疑似阻塞性睡眠呼吸暂停而转诊至学术教学医院睡眠诊所的参与者的连续实验室诊断睡眠研究数据进行评估。对诊断为OSA（呼吸暂停-低通气指数bb50事件/小时睡眠）的肥胖和非肥胖患者进行基线和随访（长达22个月）的睡眠和人体测量参数检查和比较。呼吸唤醒阈值是OSA发病机制的一个关键的非解剖学因素，并在两组之间进行比较。结果：被诊断为OSA的参与者中，25%的人体重指数（BMI）在正常范围内（BMI < 25 kg/m(2)）， 54%的人BMI < 30 kg/m(2)（非肥胖）。在处方持续气道正压通气（CPAP）的患者中，更多的非肥胖患者报告在随访中根本没有使用CPAP机器（36%对13%，p = 0.03）。非肥胖OSA患者的CPAP依从性也较低（5.1 +/- 0.4 vs. 6.4 +/- 0.4 h/夜，p < 0.03）。与肥胖OSA患者相比，非肥胖患者低呼吸唤醒阈值的比例更高（86%对60%，p < 0.001）。结论：很大一部分OSA患者并非肥胖。这些患者对现有的治疗方法具有挑战性，因为他们对CPAP治疗的依从性和依从性较低。OSA的非解剖性因素，即如此低的觉醒阈值，可能在非肥胖OSA患者的OSA发病机制中尤为重要。这些发现对非肥胖患者的OSA发病机制和这组患者的潜在治疗靶点具有重要意义。
Study Objectives: To determine the proportion and physiological characteristics of nonobese patients with obstructive sleep apnea (OSA) and their response to prescribed therapy.Methods: Data from 163 consecutive in-laboratory diagnostic sleep studies for participants referred to an academic teaching-hospital sleep clinic for suspected OSA were assessed. Sleep and anthropometric parameters at baseline and follow-up (up to 22 mo) were examined and compared between obese and nonobese patients with a diagnosis of OSA (apnea-hypopnea index > 5 events/h sleep). A key nonanatomical contributor to OSA pathogenesis, the respiratory arousal threshold, was compared between groups.Results: Twenty-five percent of the participants with a diagnosis of OSA had a body mass index (BMI) within the normal range (BMI < 25 kg/m(2)) and 54% had a BMI < 30 kg/m(2) (nonobese). Of the patients prescribed continuous positive airway pressure (CPAP), more nonobese patients reported not using their CPAP machine at all at follow-up (36% vs. 13%, p = 0.03). Objective CPAP compliance was also lower in the nonobese patients with OSA (5.1 +/- 0.4 vs. 6.4 +/- 0.4 h/night, p < 0.03). A higher proportion of the nonobese patients had a low respiratory arousal threshold compared to obese OSA patients (86% vs. 60%, p < 0.001).Conclusions: A substantial proportion of patients with OSA are not obese. These patients are challenging to treat with existing therapies as they are less adherent and compliant with CPAP therapy. Nonanatomical contributors to OSA, such a low threshold for arousal, are likely to be particularly important in OSA pathogenesis in nonobese patients with OSA. These findings have important implications for the pathogenesis of OSA in nonobese patients and potential therapeutic targets for this group of patients.