Hypoxic burden and sleep hypoventilation in obese patients

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY Sleep medicine Pub Date : 2024-12-01 Epub Date: 2024-09-08 DOI:10.1016/j.sleep.2024.09.007

L. Beauvais , A. Gillibert , A. Cuvelier , E. Artaud-Macari , M.-A. Melone

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Abstract

Introduction

Novel biomarkers of hypoxic load have emerged, as sleep apnea-specific hypoxic burden which provides more precise assessment of intermittent hypoxemia severity. Our main objective was to assess the potential benefit of hypoxic burden to identify obesity-related sleep hypoventilation. We hypothesized that hypoxic burden may help diagnose obesity-related sleep hypoventilation better than usual sleep respiratory measures (i.e., apnea-hypopnea index (AHI), mean SpO₂, time with SpO₂ < 90 %).

Methods

This retrospective study was conducted from June 2022 to October 2023 at the University Hospital of Rouen, France. All consecutive obese patients (BMI ≥30 kg/m²), adults, with no other respiratory or neurological diseases who underwent a polysomnography or polygraphy with concomitant capnography were included. Sleep hypoventilation was defined according to American Academy of Sleep Medicine criteria based on transcutaneous CO₂ monitoring (PtcCO₂). Diagnostic performance of sleep-related respiratory measures i.e., sleep apnea-specific hypoxic burden, apnea-hypopnea index (AHI), mean SpO₂, time with SpO₂ < 90 % was evaluated using Receiver Operating Characteristic (ROC) curves. Correlations between sleep-related respiratory measures were assessed by a Spearman correlation matrix.

Results

Among 107 obese patients with analyzed capnography, 37 (35 %) had sleep hypoventilation. Patients were 53 ± 14 years old, mean BMI = 38 ± 6 kg/m², mean AHI = 26.5 ± 25/h, mean hypoxic burden = 67 ± 109 %min/h, mean SpO₂ = 91.5 ± 3 %, mean time with SpO₂<90 % = 19.4 ± 28 %, mean PtcCO₂ = 6.2 ± 0.7 kPa. A low positive correlation was found between hypoxic burden and mean PtcCO₂ (r = 0.4, p < 0.001). Multivariate logistic regression model explaining sleep hypoventilation was insufficient with area under ROC curve of hypoxic burden estimated at 0.74 (95 % CI 0.65 to 0.84).

Conclusion

Hypoxic burden has low correlation with transcutaneous CO₂ pressure and a low ability to diagnose obesity-related sleep hypoventilation.

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肥胖患者的缺氧负担和睡眠通气不足

导言：缺氧负荷的新型生物标志物已经出现，如睡眠呼吸暂停特异性缺氧负荷可更精确地评估间歇性低氧血症的严重程度。我们的主要目的是评估缺氧负荷对识别肥胖相关睡眠通气不足的潜在益处。我们假设，与通常的睡眠呼吸测量（即呼吸暂停-低通气指数 (AHI)、平均 SpO2、SpO2 < 90 % 的时间）相比，缺氧负担可能更有助于诊断与肥胖相关的睡眠通气不足。方法这项回顾性研究于 2022 年 6 月至 2023 年 10 月在法国鲁昂大学医院进行。研究对象包括所有连续接受多导睡眠图或多导睡眠图检查并同时接受了毛细血管通气检查的肥胖患者（体重指数≥30 kg/m2），均为成年人，无其他呼吸系统或神经系统疾病。根据美国睡眠医学会基于经皮二氧化碳监测（PtcCO2）的标准对睡眠低通气进行定义。使用接收者操作特征曲线（ROC）评估了睡眠相关呼吸测量的诊断性能，即睡眠呼吸暂停特异性缺氧负担、呼吸暂停-低通气指数（AHI）、平均 SpO2、SpO2 < 90 % 的时间。通过斯皮尔曼相关矩阵评估了睡眠相关呼吸指标之间的相关性。结果在107名进行了毛细血管通气分析的肥胖患者中，37人（35%）存在睡眠通气不足。患者年龄为 53 ± 14 岁，平均体重指数 = 38 ± 6 kg/m2，平均 AHI = 26.5 ± 25/h，平均缺氧负担 = 67 ± 109 %min/h，平均 SpO2 = 91.5 ± 3 %，SpO2<90 % 的平均时间 = 19.4 ± 28 %，平均 PtcCO2 = 6.2 ± 0.7 kPa。缺氧负荷与平均 PtcCO2 之间存在较低的正相关性（r = 0.4，p <0.001）。结论缺氧负荷与经皮二氧化碳压力的相关性较低，诊断与肥胖相关的睡眠通气不足的能力较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.