阻塞性睡眠呼吸暂停临床亚型的聚类分析及组间低觉醒阈情况差异

Cluster analysis of clinical subtypes of obstructive sleep apnea and the difference in the presence of low arousal threshold

目的运用聚类分析评估阻塞性睡眠呼吸暂停(OSA)的潜在临床亚型及相应临床特点,探讨不同亚型间可能的低觉醒阈情况差异。方法本研究为横断面研究。采用非随机抽样的方法选取2020年2月至2022年1月于北京协和医院睡眠监测中心就诊的154例OSA患者,纳入20种主诉症状、6种合并症,及2种量表进行聚类分析,并比较不同组间临床特征及低觉醒阈情况。结果所有患者经聚类分析分为3组:睡眠紊乱组37例(24.02%)、日间嗜睡组49例(31.82%)和轻微症状组68例(44.16%)。睡眠紊乱组以入睡困难及影响睡眠质量等主观症状的情况多见,与其他2组比较,匹兹堡睡眠质量指数(PSQI)评分高,睡眠效率较日间嗜睡组低,差异均有统计学意义(P值均<0.05);48.65%存在低觉醒阈的情况。日间嗜睡组以突出的嗜睡症状为主要表现,与其他2组比较,Epworth嗜睡量表(ESS)评分高,多导睡眠监测(PSG)指标最严重,差异均有统计学意义(P值均<0.05);存在低觉醒阈的情况最少(32.65%)。轻微症状组较其他2组各类症状发生率、ESS评分及PSQI评分均低,差异均有统计学意义(P值均<0.05);存在低觉醒阈的可能性高(54.41%),但与睡眠紊乱组间比较差异无统计学意义(P>0.05)。3组合并症情况比较差异均无统计学意义(P值均>0.05)。结论由聚类分析获得的不同组OSA患者表现为不同临床特征,且各组间存在觉醒阈差异表现,有助于进一步明确不同亚型OSA患者的特点,指导个体化治疗。

Objective To evaluate the underlying clinical subtypes of obstructive sleep apnea(OSA)and its clinical characteristics by cluster analysis,and discuss possible differences in the presence of low arousal threshold between subtypes.Methods This is a cross-sectional study,and a non-random sampling method was used.A total of 154 OSA patients who visited the Sleep Monitoring Center of Peking Union Medical College Hospital from February 2020 to January 2022 were enrolled,there were 20 main manifestation and 6 comorbidities in those patients,the cluster analysis were performed by 2 assessment scales.The clinical characteristics and low arousal threshold between groups were compared.Results All patients were divided into 3 groups by cluster analysis:sleep disorder group(37 cases,24.02%),daytime sleepiness group(49 cases,31.82%)and mild symptom group(68 cases,44.16%).In the sleep disorder group,difficulty falling asleep and sdubjective negatively affecting sleep quality were more common;the Pittsburgh Sleep Quality Index(PSQI)score was significantly higher compared with the other two groups,and the sleep efficiency was lower than the daytime sleepiness group,and the differences were statistically significant(P<0.05);48.65%of them had low arousal threshold.In the daytime sleepiness group,the prominent sleepiness symptoms was main manifestation,the Epworth Sleepiness Scale(ESS)score and polysomnography(PSG)index were significantly higher(all P<0.05);the lowest percentage of patients with low arousal threshold was present(32.65%).In the mild symptom group,the incidence of various symptoms,ESS score and PSQI score were significantly lower than those in the other two groups(P<0.05).The possibility in the presence of low arousal threshold was higher(54.41%),but there was no significant difference in low arousal threshold between the mild symptom group and the sleep disorder group(P>0.05).There was no significant difference in the complication among the three groups(all P>0.05).Conclusions Cluster analysis showed the clinical characteristics of OSA patients in different group,and there were differences in arousal thresholds between groups,which was helpful to further guide individualized treatment based on the characteristics of patients with different subtypes of OSA.