阻塞性睡眠呼吸暂停临床亚型的潜在类别以及对不同类别首次持续气道正压通气治疗反应的分析研究

The Latent Class of Clinical Subtypes of Obstructive Sleep Apnea and the Analysis of Characteristics of Initial Exposure to CPAP Therapy

背景阻塞性睡眠呼吸暂停(OSA)具有高度异质性,不同临床亚型提示不同的临床特点。本研究团队前期研究发现不同OSA临床亚型在初次持续气道正压通气(CPAP)治疗上存在显著差异性,但目前国内外缺乏相关研究。目的使用潜在类别分析探索OSA患者中存在的临床亚型,分析不同临床亚型诊断夜(首次CPAP治疗前)睡眠特征和对首次CPAP治疗反应的差异。方法回顾性分析了2011年1月—2016年12月在唐都医院睡眠中心进行首次CPAP治疗的491例OSA患者的临床资料。将22种临床症状(入睡困难、多醒、早醒、打鼾、憋气、突然憋醒、梦魇、梦话、尿床、睡眠中肢体抽动、晨起头痛、头昏、焦虑、情绪低落、思维困难、注意力不集中、头脑不清、反应迟钝、工作能力减退、心悸、疲劳乏力、白日嗜睡)纳入潜在类别分析模型。比较不同临床亚型症状分布特点、诊断夜的睡眠特征以及首次CPAP治疗反应的差异性。结果临床亚型数目为4时,模型拟合最佳,分为类别1“呼吸中断伴白日嗜睡组”143例(29.1%),类别2“症状轻微组”189例(38.5%),类别3“日间功能严重受损组”64例(13.0%)和类别4“合并失眠组”95例(19.3%)。类别2“症状轻微组”年龄更小,男性比例更高,而类别4“合并失眠组”正好相反。不同临床亚型除外憋气症状,其余临床症状占比比较,差异均有统计学意义(P<0.05)。不同临床亚型OSA患者诊断夜的睡眠潜伏期(SL)、N1%、N2%、N3%、快速眼动睡眠期占总睡眠时期的比例(REM%)比较,差异均有统计学意义(P<0.05)。不同临床亚型OSA患者接受首次CPAP治疗后的总睡眠时间(TST)、睡眠效率(SE)、N1%、N2%、N3%、REM%、入睡后清醒时间(WASO)、氧饱和度下降指数(ODI)、血氧饱和度(SpO2)<90%的时间、最低SpO2(LSpO2)、整夜平均SpO2比较,差异均有统计学意义(P<0.05)。结论通过潜在类别分析,可以将OSA的临床症状分为4种临床亚型,且4种临床亚型首次CPAP治疗反应存在统计学差异。这些发现强调了识别一系列OSA临床症状,进行个体化治疗的必要性。

Background Obstructive sleep apnea(OSA)is a highly heterogeneous disorder,and different subtypes suggest different characteristics.In the previous study,we found that there was significant diversity of initial exposure to continuous positive airway pressure(CPAP)therapy among OSA physiologic phenotypes.However,a detailed description for this problem is lacking in current at home and abroad.Objective To use latent class analysis to explore the clinical subtypes of OSA patients,and to analyze the differences of diagnostic polysomnography(PSG)before and after initial exposure to CPAP therapy among different subtypes.Methods The study retrospectively analyzed data for 491 OSA patients who underwent initial exposure to CPAP therapy at the Tangdu Hospital Sleep Medicine Center from January 2011 to December 2016.22 kinds of clinical symptoms:difficulty falling asleep,multiple awaking,early awaking,snoring,apnea,sudden awaking with breath holding,nightmare,dreamtalk,enuresis,limb twitching during sleep,morning headache,dizziness,anxiety,depression,cognition dysfunction,lack of concentration,confusion,impaired reaction time,work impairment,palpitation,fatigue and daytime sleepiness were included in the latent category analysis model.Then the symptoms distribution,sleep characteristics of diagnostic PSG and responses to initial CPAP therapy among different subtypes were compared.Results A model with four phenotype clusters provided the best fit:cluster 1"apnea with daytime sleepiness group"(143 cases,29.1%),cluster 2"minimally symptomatic group"(189 cases,38.5%),cluster 3"severely impaired daytime function group"(64 cases,13.0%)and cluster 4"combined with insomnia group"(95 cases,19.3%).The average age of cluster 2"minimally symptomatic group"was younger and have a higher proportion of men,while the opposite result of cluster 4"combined insomnia group".Statistical differences were observed among all the OSA symptoms(P<0.05),with the exception of apnea.There were statistically significant differences for sleep latency(SL),N1%,N2%,N3%,REM%of diagnostic PSG among four subtypes(P<0.05).These differences for total sleep in tim(e TST),sleep efficienc(y SE),N1%,N2%,N3%,REM%,wake after sleep onse(t WASO),oxygen desaturation index(ODI),time spent at pulse oxygen saturation(SpO2)below 90%,the lowest SpO2(LSpO2),average SpO2 after initial exposure to CPAP treatment were also statistically significant(P<0.05).Conclusion The clinical symptoms of OSA can be divided into four clinical subtypes by latent class analysis,and initial exposure to CPAP treatment of four clinical subtypes is statistically different.These findings emphasize the need to identify a series of OSA clinical symptoms and carry out individualized treatment.