Ankit Parekh, Korey Kam, Sajila Wickramaratne, Thomas M Tolbert, Andrew Varga, Ricardo Osorio, Monica Andersen, Luciana B M de Godoy, Luciana O Palombini, Sergio Tufik, Indu Ayappa, David M Rapoport
{"title":"Ventilatory Burden as a Measure of Obstructive Sleep Apnea Severity Is Predictive of Cardiovascular and All-Cause Mortality.","authors":"Ankit Parekh, Korey Kam, Sajila Wickramaratne, Thomas M Tolbert, Andrew Varga, Ricardo Osorio, Monica Andersen, Luciana B M de Godoy, Luciana O Palombini, Sergio Tufik, Indu Ayappa, David M Rapoport","doi":"10.1164/rccm.202301-0109OC","DOIUrl":null,"url":null,"abstract":"<p><p><b>Rationale:</b> The apnea-hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations. <b>Objectives:</b> We propose a novel automated measure, termed \"ventilatory burden\" (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI. <b>Methods:</b> Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to <i>1</i>) derive the normative range of VB, <i>2</i>) assess the relationship between degree of upper airway obstruction and VB, and <i>3</i>) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm. <b>Measurements and Main Results:</b> The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VB<sub>EPISONO</sub>, 5.5 [3.5-9.7]%; VB<sub>DAYFUN</sub>, 9.8 [6.4-15.6]%). VB was associated with the degree of upper airway obstruction in a dose-response manner (VB<sub>untreated</sub>, 31.6 [27.1]%; VB<sub>treated</sub>, 7.2 [4.7]%; VB<sub>suboptimally treated</sub>, 17.6 [18.7]%; VB<sub>off-treatment</sub>, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort. <b>Conclusions:</b> Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1216-1226"},"PeriodicalIF":19.3000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10868353/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of respiratory and critical care medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1164/rccm.202301-0109OC","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale: The apnea-hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations. Objectives: We propose a novel automated measure, termed "ventilatory burden" (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI. Methods: Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to 1) derive the normative range of VB, 2) assess the relationship between degree of upper airway obstruction and VB, and 3) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm. Measurements and Main Results: The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VBEPISONO, 5.5 [3.5-9.7]%; VBDAYFUN, 9.8 [6.4-15.6]%). VB was associated with the degree of upper airway obstruction in a dose-response manner (VBuntreated, 31.6 [27.1]%; VBtreated, 7.2 [4.7]%; VBsuboptimally treated, 17.6 [18.7]%; VBoff-treatment, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort. Conclusions: Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI.
原理:用于诊断阻塞性睡眠呼吸暂停的呼吸暂停低通气指数(AHI)仅捕获呼吸事件的频率，并且具有明显的局限性。目的:我们提出了一种新的自动化测量方法，称为“通气负荷”(VB)，它代表了低于50%归一化幅度的夜间呼吸的比例，并证明了其克服AHI局限性的能力。方法:数据来自两个流行病学队列(EPISONO[圣保罗流行病学研究]和SHHS[睡眠心脏健康研究])和两个回顾性临床队列(DAYFUN;在本研究中使用了纽约大学脑健康中心(New York University Center for Brain Health)的数据，以1)推导出VB的标准范围，2)评估上呼吸道阻塞程度与VB之间的关系，以及3)评估VB与有或无缺氧负担的全因和心血管疾病(CVD)死亡率之间的关系，这些数据是使用内部自动算法得出的。测量和主要结果:EPISONO和DAYFUN两组无症状健康受试者的VB第95百分位数分别为25.2%和26.7%(中位数[四分位数范围]，VBEPISONO为5.5 [3.5- 9.7%]%;Vbdayfun, 9.8[6.4-15.6]%)。VB与上气道阻塞程度呈剂量-反应关系(vbuntreat, 31.6% [27.1]%;vbtreatment, 7.2 [4.7]%;vb次优处理，17.6 [18.7]%;vboff处理，41.6[18.1]%)，表现出较低的夜间变异性(类内相关系数[2,1]，0.89)。在包括缺氧负担在内的协变量调整前后，VB可预测SHHS队列的全因死亡率和CVD死亡率。尽管AHI可以预测全因死亡率，但在SHHS队列中，它与CVD死亡率无关。结论:自动VB可有效评估阻塞性睡眠呼吸暂停严重程度，预测全因和CVD死亡率，可能是AHI的可行替代方法。
期刊介绍：
The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences.
A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
