Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea
Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea
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DOI：
10.5664/jcsm.7112
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发表时间：
2018-01-01
影响因子：
4.3
通讯作者：
Yaggi, Henry K.
中科院分区：
文献类型：
--
作者：
Zinchuk, Andrey;Edwards, Bradley A.;Yaggi, Henry K.
研究目的：确定阻塞性睡眠呼吸暂停(OSA)患者中低呼吸觉醒阈值(ARTH)的发生率及其相关的临床特征，并评估低ARTH是否与减少长期使用CPAP有关。方法：对940名患有OSA的男性退伍军人进行横断面和纵向分析。临床特征、多导睡眠图特征和长期(5+/-2年)CPAP使用的数据来自临床记录。结果：38%的受试者ARTH降低，在非肥胖者(体重指数为30 kg/m(2))患者中更为常见(55%)。在调整后的分析中，增加体重指数(每5 kg/m(2))和使用抗高血压药物与低ARTH呈负相关，优势比(OR)(95%可信区间[CI])分别为0.77(0.69，0.87)和0.69(0.49，0.98)。相反，年龄增加(每10年)和抗抑郁药物的使用-OR(95%CI)1.15(1.01，1.31)和1.54(1.14，1.98)-与低髓核呈正相关。在调整后的模型中，ARTH低的非肥胖患者不太可能经常使用CPAP-OR(95%CI)0.38(0.20，0.72)。结论：ARTH低是OSA退伍军人的共同特征，在年龄较大、非肥胖者和服用抗抑郁药物的患者中更常见，但在服用降压药的患者中较少发生。在低ARTH的非肥胖症患者中，长期使用CPAP的显著减少突出了了解专利患者的生理表型对于OSA治疗的重要性，并提出了改善CPAP依从性的潜在目标。
Study Objectives: Determine the prevalence of, and clinical features associated with, a low respiratory arousal threshold (ArTH) among patients with obstructive sleep apnea (OSA), and to assess whether a low ArTH is associated with reduced long-term CPAP use.Methods: Cross-sectional and longitudinal analyses were performed in an observational study conducted among 940 male Veterans with OSA. Data for clinical characteristics, polysomnography characteristics, and long-term (5 +/- 2 years) CPAP use were obtained from clinical records. Logistic regression was used to assess the associations between low ArTH and clinical features, including regular CPAP use.Results: A low ArTH was observed in 38% of participants overall, and was more common among nonobese (body mass index < 30 kg/m(2)) patients (55%). In adjusted analyses, increasing body mass index (per 5 kg/m(2)) and antihypertensive medication use were negatively associated with low ArTH, with odds ratio (OR) (95% confidence interval [CI]) of 0.77 (0.69, 0.87) and 0.69 (0.49, 0.98), respectively. Conversely, increasing age (per 10 years) and antidepressant use-OR (95% CI) 1.15 (1.01,1.31) and 1.54 (1.14,1.98), respectively-were positively associated with low PITH. Nonobese patients with low ArTH were less likely to be regular CPAP users-OR (95%CI) 0.38 (0.20, 0.72)-in an adjusted model.Conclusions: Low ArTH is a common trait among Veterans with OSA and is more frequent among those who are older and nonobese and those taking antidepressants, but is less frequent among patients taking antihypertensive medications. A marked reduction of long-term CPAP use in nonobese patients with low ArTH highlights the importance of understanding a patent's physiologic phenotype for OSA management, and suggests potential targets to improve CPAP adherence.