Clinical Predictors of the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea
Clinical Predictors of the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea
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DOI：
10.1164/rccm.201404-0718oc
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发表时间：
2014-12-01
影响因子：
24.7
通讯作者：
Malhotra, Atul
中科院分区：
文献类型：
--
作者：
Edwards, Bradley A.;Eckert, Danny J.;Malhotra, Atul
理由：低呼吸觉醒阈值（ArTH）是阻塞性睡眠呼吸暂停发病机制的几个特征之一，可能是一个治疗靶点；然而，在没有侵入性测量的情况下，没有简单的方法来识别患者。目的：确定ArTH的生理决定因素，并开发一种临床工具来识别低ArTH患者。方法：收集146名参与者的人体测量数据，这些参与者使用会厌导管进行夜间多导睡眠检查，以测量唤醒前会厌最低点压力。随机选择20个非快速眼动和快速眼动呼吸事件测量ArTH。采用多元线性回归确定ArTH的独立预测因子。采用Logistic回归方法建立临床评分系统。测量结果和主要结果：脉搏血氧仪测量的最低血氧饱和度、呼吸暂停-低呼吸指数和低呼吸事件的比例（f -低呼吸）是ArTH的独立预测因子(r(2) = 0.59；P < 0.001)。利用这些信息，我们使用受试者工作特征分析和逻辑回归来制定临床评分来预测低ArTH，并为满足的每个标准分配1分：（呼吸暂停-低呼吸指数，82.5%）+ （f -低呼吸指数，58.3%）。2分或以上正确预测了84.1%的参与者的低唤醒阈值，灵敏度为80.4%，特异性为88.0%，这一发现通过留一交叉验证分析得到了证实。结论：我们的结果表明，低ArTH的个体可以从标准的、临床可用的变量中识别出来。这一发现可以促进针对ArTH的更大规模的介入研究。
Rationale: A low respiratory arousal threshold (ArTH) is one of several traits involved in obstructive sleep apnea pathogenesis and may be a therapeutic target; however, there is no simple way to identify patients without invasive measurements.Objectives: To determine the physiologic determinates of the ArTH and develop a clinical tool that can identify patients with low ArTH.Methods: Anthropometric data were collected in 146 participants who underwent overnight polysomnography with an epiglottic catheter to measure the ArTH (nadir epiglottic pressure before arousal). The ArTH was measured from up to 20 non-REM and REM respiratory events selected randomly. Multiple linear regression was used to determine the independent predictors of the ArTH. Logistic regression was used to develop a clinical scoring system.Measurements and Main Results: Nadir oxygen saturation as measured by pulse oximetry, apnea-hypopnea index, and the fraction of events that were hypopneas (F-hypopneas) were independent predictors of the ArTH (r(2) = 0.59; P < 0.001). Using this information, we used receiver operating characteristic analysis and logistic regression to develop a clinical score to predict a low ArTH, which allocated a score of 1 to each criterion that was satisfied: (apnea-hypopnea index, 82.5%) + (F-hypopneas >58.3%). A score of 2 or above correctly predicted a low arousal threshold in 84.1% of participants with a sensitivity of 80.4% and a specificity of 88.0%, a finding that was confirmed using leave-one-out cross-validation analysis.Conclusions: Our results demonstrate that individuals with a low ArTH can be identified from standard, clinically available variables. This finding could facilitate larger interventional studies targeting the ArTH.