Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea
Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea
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DOI：
10.5664/jcsm.6716
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发表时间：
2017-01-01
影响因子：
4.3
通讯作者：
Owens, Robert
中科院分区：
文献类型：
--
作者：
Li, Yanru;Ye, Jingying;Owens, Robert
研究目的：为了测试是否在一个基于生理学的模型中整合解剖学和非解剖学参数（呼吸控制，唤醒阈值，肌肉反应性）将提高预测阻塞性睡眠呼吸暂停（OSA）上气道手术后结果的能力，方法：在31例因OSA接受上气道手术的患者中，从术前多导睡眠图（PSG）计算回路增益和唤醒阈值。比较了三种模型：（1）仅基于广泛的PSG参数列表的多元回归;（2）使用PSG参数加上PSG衍生的环路增益、觉醒阈值和其他特征替代品的估计的多元回归;（3）包含选定变量的生理模型作为替代品对于OSA发病机制很重要的解剖和非解剖特征。结果：虽然术前袢增益与术后呼吸暂停低通气指数（AHI）呈正相关，（P =.008）和唤醒阈值呈负相关（P = 0.011），在模型1和2中，唯一的显著变量是术前AHI，其解释了术后AHI方差的42%。与此相反，生理模型（模型3），其中包括AHIREM（解剖学术语），呼吸不足事件的分数（唤醒术语），AHIREM和AHINREM的比率（肌肉反应性术语）、袢增益和中枢性/混合性呼吸暂停指数（控制呼吸术语），能够解释术后AHI的61%的变异。虽然环路增益和唤醒阈值与术后残余AHI相关，但使用多变量回归模型，仅术前AHI具有预测性。相反，将选定的替代生理性状的基础上，OSA的病理生理学创建了一个模型，有更多的关联与实际残留AHI。评论：关于这篇文章的评论出现在本期的第1023页。
Study Objectives: To test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA).Methods: In 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis.Results: Although preoperative loop gain was positively correlated with postoperative apnea-hypopnea index (AHI) (P =.008) and arousal threshold was negatively correlated (P =.011), in both model 1 and 2, the only significant variable was preoperative AHI, which explained 42% of the variance in postoperative AHI. In contrast, the physiological model (model 3), which included AHIREM (anatomy term), fraction of events that were hypopnea (arousal term), the ratio of AHIREM and AHINREM (muscle responsiveness term), loop gain, and central/ mixed apnea index (control of breathing terms), was able to explain 61% of the variance in postoperative AHI.Conclusions: Although loop gain and arousal threshold are associated with residual AHI after surgery, only preoperative AHI was predictive using multivariate regression modeling. Instead, incorporating selected surrogates of physiological traits on the basis of OSA pathophysiology created a model that has more association with actual residual AHI. Commentary: A commentary on this article appears in this issue on page 1023.