Continuous positive airway pressure and adherence in patients with different endotypes of obstructive sleep apnea.
Continuous positive airway pressure and adherence in patients with different endotypes of obstructive sleep apnea.
复制标题
不同内型阻塞性睡眠呼吸暂停患者的持续气道正压通气和依从性。
DOI：
10.1111/jsr.13999
复制
发表时间：
2024
影响因子：
4.4
通讯作者：
Hang,Liang-Wen
中科院分区：
文献类型：
--
作者：
Cheng,Wan-Ju;Finnsson,Eysteinn;Ágústsson,JónS;Sands,ScottA;Hang,Liang-Wen
确定阻塞性睡眠呼吸暂停(OSA)的内分泌类型对精确干预具有潜在意义。在这里，我们评估了持续气道正压(CPAP)治疗结果是否因内型亚组不同而不同。我们对225例中重度OSA患者从一个睡眠中心获得的数据进行了回顾性分析。多导睡眠图和CPAP滴定研究数据收集于2020年5月至2022年1月之间。随访1个月的CPAP治疗依从性。通过多导睡眠图评估阻塞性睡眠呼吸暂停的内型，即觉醒阈值、塌陷性、环路增益和上呼吸道增益，并将其分为高和低两组。我们研究了内型亚组与(1)最佳CPAP滴定压力、(2)与CPAP相关的睡眠结构改善(慢波睡眠和快速眼动(REM)睡眠的比例)以及(3)CPAP依从性之间的关系。我们观察到，与低湿陷性患者相比，高湿陷性患者需要更高的CPAP压力(∆ = 0.4cmH2O，95%可信区间[CI] = 0.3-1.7)。高觉醒阈值、高塌陷、高环路增益或高上呼吸道增益的患者在CPAP治疗后慢波睡眠和REM睡眠比例的增加比内型者更大。高环路增益和高可崩解性与每晚较长的CPAP使用时间独立相关(∆ = 分别为0.6 h，95%CI = 0.2-1.5和∆ = 0.3 h，95%CI = 0.03-1.5)。综上所述，不同的OSA内型亚组在CPAP治疗结果上存在差异。内型知识可能有助于临床医生在给予CPAP治疗之前了解哪些患者有望从CPAP治疗中获益最多。
Determining the endotypes of obstructive sleep apnea (OSA) has potential implications for precision interventions. Here we assessed whether continuous positive airway pressure (CPAP) treatment outcomes differ across endotypic subgroups. We conducted a retrospective analysis of data obtained from 225 patients with moderate‐to‐severe OSA from a single sleep centre. Polysomnographic and CPAP titration study data were collected between May 2020 and January 2022. One‐month CPAP treatment adherence was followed. Obstructive sleep apnea endotypes, namely arousal threshold, collapsibility, loop gain, and upper airway gain were estimated from polysomnography and dichotomised as high versus low. We examined associations between endotypic subgroups and (1) optimal CPAP titration pressure, (2) CPAP‐related improvements in sleep architecture (proportions of slow‐wave and rapid eye movement (REM) sleep), and (3) CPAP adherence. We observed that patients with high collapsibility required a higher CPAP pressure than those with low collapsibility (∆ = 0.4 cmH2O, 95% confidence interval [CI] = 0.3–1.7). A larger increase in slow‐wave sleep and in REM sleep proportions after CPAP treatment were observed in patients with a high arousal threshold, high collapsibility, high loop gain, or high upper airway gain than in those with low levels of endotypes. High loop gain and high collapsibility were independently associated with longer CPAP use hours per night (∆ = 0.6 h, 95% CI = 0.2–1.5 and ∆ = 0.3 h, 95% CI = 0.03–1.5, respectively). In conclusion, different endotypic subgroups of OSA exhibit a difference in outcomes of CPAP treatment. Knowledge of endotypes may help clinicians to understand which patients are expected to benefit most from CPAP therapy prior to its administration.