Mortality in middle-aged men with obstructive sleep apnea in Finland

Introduction

Obstructive sleep apnea (OSA) has been associated with an elevated rate of cardiovascular mortality. However, this issue has not been investigated in patients with elevated proneness to cardiovascular diseases. Our hypothesis was that OSA would have an especially adverse effect on the risk of cardiovascular mortality in Finnish individuals exhibiting elevated proneness for coronary heart diseases.

Methods

Ambulatory polygraphic recordings from 405 men having suspected OSA were retrospectively analyzed. The patients were categorized regarding sleep disordered breathing into a normal group (apnea hypopnea index (AHI)?<?5, n?=?104), mild OSA group (5?≤?AHI?<?15, n?=?100), and moderate to severe OSA group (AHI?≥?15, n?=?201). In addition, basic anthropometric and health data were collected. In patients who died during the follow-up period (at least 12 years and 10 months), the primary and secondary causes of death were recorded.

Results

After adjustment for age, BMI, and smoking, the patients with moderate to severe OSA suffered significantly (p?<?0.05) higher mortality (hazard ratio 3.13) than their counterparts with normal recordings. The overall mortality in the moderate to severe OSA group was 26.4 %, while in the normal group it was 9.7 %. Hazard ratio for cardiovascular mortality was 4.04 in the moderate to severe OSA and 1.87 in the mild OSA group.

Conclusions

OSA seems to have an especially adverse effect on the cardiovascular mortality of patients with an elevated genetic susceptibility to coronary heart diseases. When considering that all our patients had possibility of continuous positive airway pressure treatment and our reference group consisted of patients suffering from daytime somnolence, the hazard ratio of 4.04 for cardiovascular mortality in patients with moderate to severe disease is disturbingly high.     

Endothelial dysfunction and inflammatory reactions of elderly and middle-aged men with obstructive sleep apnea syndrome

Introduction  Obstructive sleep apnea syndrome (OSAS) is considered to be associated with cardiovascular complications, and atherosclerosis could mediate this relationship. Cardiovascular risk factors of OSAS still need to be elucidated in elderly patients, since studies about the association between OSAS and cardiovascular diseases have been done mainly in middle-aged adults. To investigate whether endothelial dysfunction, as an early marker of atherosclerosis, and inflammatory responses in OSAS were affected by age, we studied flow-mediated dilatation (FMD) and C-reactive protein (CRP) in elderly and middle-aged patients with OSAS. Materials and methods  This study enrolled 161 male subjects of 117 middle-aged (35–59 years old) and 44 elderly (≥60 years old) patients with OSAS. After they finished nocturnal polysomnography (NPSG), FMD was measured on the brachial artery and blood samples were obtained to determine serum CRP levels. Results and discussion  FMD was significantly lower in the elderly patients (p = 0.04), but no difference was observed between two age groups in body mass index (BMI), neck circumference, waist-to-hip ratio, apnea hypopnea index (AHI), serum CRP level, or NPSG findings related with nocturnal hypoxemia such as average O₂ saturation, percentage of time below 90% O₂ saturation, and oxygen desaturation index (ODI). From the results of stepwise multiple linear regression analysis, the lowest oxygen saturation was a significant determinant of FMD (β = 0.25, p < 0.01, adjusted R ² = 6%), and BMI (β = 0.22, p < 0.05) and waist-to-hip ratio (β = 0.21, p < 0.05) were significant variables to explain CRP (adjusted R ² = 11%, p < 0.01) in the middle aged patients. In the elderly patients, no variable was significant for predicting FMD, but AHI was significant determinant of CRP (β = 0.46, p < 0.01, adjusted R ² = 19%, p < 0.01). In predicting cardiovascular risks of OSAS, both hypoxia and obesity should be considered in the middle-aged group, whereas nocturnal respiratory disturbances are important in the elderly group.     

Craniofacial obesity in patients with obstructive sleep apnea

Introduction  Obstructive sleep apnea (OSA) and obesity are serious, widespread public health issues. Objective  To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA. Materials and methods  Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM). Results  The body mass index was significantly greater for the OSA group (32.3 kg/m² compared to 24.8 kg/m², p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7–22% (p < 0.05) for the OSA group. Conclusion  Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.     

Familial premature coronary artery disease mortality and obstructive sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) is linked to both coronary artery disease (CAD) and sudden death, but any causal role remains unclear. A family history of premature CAD and related mortality is an independent risk factor for the development of CAD. We hypothesized that OSA is associated with a family history of premature mortality from ischemic heart disease. METHODS: We prospectively studied 588 subjects who underwent polysomnography from May 2000 to June 2004. Demographics, comorbidities, family history of cardiovascular disease, and the ages and causes of death for 10 strata of family members were recorded for all subjects. We excluded those subjects with known causes of premature cardiac death, such as hypertrophic cardiomyopathy and long-QT syndrome. OSA was defined by American Academy of Sleep Medicine criteria (ie, apnea-hypopnea index >or= 5). Premature CAD mortality was defined as death due to ischemic heart disease or sudden cardiac death before 55 years of age (men) or 65 years of age (women). RESULTS: Polysomnography confirmed OSA in 316 subjects and excluded it in 202 subjects. The unadjusted odds ratio (OR) for OSA and a family history of premature CAD mortality was 2.11 (95% confidence interval [CI], 1.10 to 4.31; p = 0.031). After adjusting for each subject's sex, body mass index, and history of CAD, there was a significant and independent association between OSA and family history of premature CAD mortality (OR, 2.13; 95% CI, 1.04 to 4.66; p = 0.046). CONCLUSIONS: Regardless of their own CAD status, people with OSA are more likely than those without OSA to have a family history of premature CAD mortality.     

Association of serum antioxidant capacity with coronary artery disease in middle-aged men

The possible involvement of oxidative damage in the progression of atherosclerosis has been suggested. There is some evidence that antioxidant therapy may be beneficial for the prevention of coronary heart disease. In this study, we investigated the relationship between coronary artery disease (CAD) and serum antioxidative status by measuring the total antioxidant status (TAS). Other relevant antioxidants, such as retinol, alpha, gamma-tocopherol, ascorbic acid, alpha, beta-carotenoids, erythrocyte glutathione peroxidase (GSH-Px) and oxidative products, were also determined in 31 male CAD patients with angiographically defined CAD and 66 male controls, aged 40-70 years, in a case-control study. The TAS levels, ratio and the concentrations of retinol, albumin, total protein and HDL cholesterol were significantly lower in the CAD patients than in the controls (p<0.01), and alpha-tocopherol and alpha/gamma-tocopherol were significantly higher in the CAD patients than in the controls. The TAS level correlated positively with gamma-GTP, GPT, GOT and uric acid (p<0.01). A multiple regression analysis in the CAD patients revealed that the TAS levels correlated most negatively with the number of diseased vessels. The concentrations of carotenoids and GSH-Px, as well as the alpha/gamma-tocopherol ratio were also significantly associated. Although conditional logistic regression analysis suggested low levels of HDL-cholesterol to be a significant coronary risk factor (OR=5.1, 95% CI=1.09-24.3), the TAS level showed no significant independent contribution to CAD. This study demonstrated an association of antioxidant parameters with the atherosclerosis progression, however, it did not confirm antioxidants as an independent risk factor for CAD event.     

Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea

STUDY OBJECTIVES: It has been suggested that obstructive sleep apnea (OSA)-induced hypoxic stress might contribute to cardiovascular disorders by promoting expression of soluble adhesion molecules. The reported increase of circulating adhesion molecules in patients with OSA remains controversial because confounders such as cardiovascular risk factors and left ventricular function have not been adequately controlled for. We hypothesized that soluble intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, L-selectin, and E-selectin levels are correlated with OSA independent of coexisting coronary artery disease (CAD). SETTINGS: University-affiliated teaching hospitals. DESIGN AND PARTICIPANTS: A prospective study of 61 consecutive subjects with angiographically proven CAD deemed to have stable angina. INTERVENTIONS: Fifteen patients (mean +/- SD) 61.2 +/- 1.9 years old with moderate-to-severe OSA (apnea-hypopnea index [AHI] > or = 20/h) were matched to a control group (AHI < or = 5/h) for age, gender, body mass index, and severity of CAD. Venous blood samples were collected the morning of the sleep study and assayed for human ICAM-1, VCAM-1, L-selectin, and E-selectin with commercially available enzyme-linked immunosorbent assay kits. RESULTS: All but L-selectin were significantly increased in the OSA group compared to the control subjects (ICAM-1, 367.4 +/- 85.2 ng/mL vs 252.8 +/- 68.4 ng/mL, p = 0.008; VCAM-1, 961.5 +/- 281.7 ng/mL vs 639.1 +/- 294.4 ng/mL, p = 0.004; E-selectin, 81.0 +/- 30.4 ng/mL vs 58.1 +/- 23.2 ng/mL, p = 0.03, respectively). The increased levels of adhesion molecules correlated with the AHI and the oxygen desaturation index but not with the severity of hypoxemia or the frequency of arousals. CONCLUSIONS: These findings suggest that OSA modulates the expression of proinflammatory mediators. Further studies should evaluate the influence of adhesion molecules on cardiovascular outcome in CAD patients with OSA.     

Association between aortic calcification and stable obstructive coronary artery disease

Aims

Atrial fibrillation and flutter remain an important cause of morbidity in adults with atrial septal defect (ASD). This study aimed at investigating predictors for late (≥ 1 month after repair) atrial arrhythmia.

Methods

Patients who underwent ASD closure after the age of 18 years, were selected through the databases of three medical centres in Belgium. Preprocedural, periprocedural and follow-up data were extracted. Univariate and multivariate Cox-regression analysis was performed. Kaplan-Meier analysis was performed for any independent predictor of late atrial arrhythmia.

Results

A total of 155 patients (38 men and 117 women) was included. Twenty-four patients (median age 48.3 years, range 19.9-79.8) underwent surgical and 131 (median age 57.6 years, range 18.2-86.9) underwent transcatheter closure. Thirty-nine patients (25.2%) presented with late atrial arrhythmia. Male gender (P = 0.008), creatinine (P = 0.002), atrial arrhythmia before (P < 0.0001) and within 1 month after repair (P = 0.001) and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg (P < 0.0001) correlated with late atrial arrhythmia in univariate Cox-regression analysis. Multivariate analysis showed that mPAP ≥ 25 mm Hg (HR 3.72; 95%CI 1.82-7.59; P < 0.0001) and the presence of atrial arrhythmia before (HR 3.22; 95%CI 1.56-6.66; P = 0.002) and within 1 month after repair (HR 2.08; 95%CI 2.08-15.92; P = 0.001) were predictive of late atrial arrhythmia. Kaplan-Meier analysis showed that patients with a mPAP ≥ 25 mm Hg had a higher risk at developing late atrial arrhythmia (P < 0.0001).

Conclusion

In patients with ASD type secundum, a mPAP ≥ 25 mm Hg is an independent predictor of late atrial arrhythmia. The presence of pulmonary hypertension before repair should raise awareness for atrial arrhythmias and may be used to guide therapy.     

Vascular adhesion molecules in men with obstructive sleep apnea: associations with obesity and metabolic syndrome

Introduction

Mechanisms linking obstructive sleep apnea (OSA) to vascular diseases as well as obesity and metabolic syndrome are not clear. The purpose of the study was to evaluate levels of vascular adhesion molecules (soluble vascular cell adhesion molecules-1 (sVCAM-1) and E-selectin) in men with obstructive sleep apnea and control subjects and to determine their relations with obesity and metabolic syndrome.

Methods

Men with OSA and controls matched for age were included in the study. Overnight polysomnography was performed. Body mass index (BMI) and all the components of metabolic syndrome were evaluated. Serum levels of sVCAM-1 and E-selectin were measured by enzyme-linked immunosorbent assay. Data presented as median (25th and 75th percentiles).

Results

Levels of sVCAM-1 (698.2 (627.6–798.2) vs 565.5 (518.8–678.1)?ng/ml, p?=?0.003) and E-selectin (64.9 (50.1–83.1) vs 49.7 (39.8–59.5)?ng/ml, p?=?0.017) were higher in the OSA group compared to the controls. Half of OSA patients had metabolic syndrome. Serum levels of sVCAM-1 and E-selectin did not differ in OSA patients with and without metabolic syndrome. Concentrations of both vascular adhesion molecules correlated with oxygen desaturation index (ODI), but the relation was no more significant after adjustment for all the components of metabolic syndrome. After adjustment for BMI, sVCAM-1 levels positively correlated with oxygen desaturation index (r?=?0.331, p?=?0.009).

Conclusions

Serum levels of sVCAM-1 and E-selectin were increased in the OSA patient group compared to the controls. sVCAM-1 showed relation with ODI after adjustment for BMI suggesting that it could contribute to development of cardiovascular consequences in OSA patients.     

Severity of obstructive sleep apnea and extension of coronary artery disease

Sleep and Breathing - Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD). The relationship between the severity of OSA and the severity of CAD has...     

Association between serum neopterin, obesity and daytime sleepiness in patients with obstructive sleep apnea

OBJECTIVE: Obesity and obstructive sleep apnea (OSA) and systemic inflammation may interact through biochemical pathways. Neopterin (NP) is a monocyte/macrophage activation marker produced by macrophages in response to interferon-gamma secreted by activated T-lymphocytes. This study examines the association between NP, obesity and OSA. PATIENTS AND METHODS: The study included 22 newly diagnosed OSA (+) patients and 18 OSA (-) patients. Subjects with history of coronary artery disease, transplant patients, history of alcohol and drug abuse, history of HIV and any other significant medical illnesses such as active infections, autoimmune disease, malignancy, liver disease, pulmonary disease (COPD, asthma,...), neuromuscular disease, patients on immunomodulating therapy or HMG-CoA reductase inhibitors were excluded. RESULTS: There were no significant differences in age, body mass index (BMI), and smoking habits of the OSA (+) patients and OSA (-) patients. Serum NP levels did not show any significant difference between the OSA (+) patients and OSA (-) patients, however, NP levels were positively correlated with BMI (r=0.320, p=0.044). There was no significant correlation between NP and any of the polysomnographic parameters. The result of stepwise regression analyses (r(2)=0.320, p<0.001) showed that high serum NP levels (p=0.004) and apnea-hypopnea index (AHI) were a risk factor for elevated Epworth sleepiness score, independent of BMI. CONCLUSION: We suggest that serum NP levels correlate with BMI. There was a significant relationship between serum NP levels and excessive daytime sleepiness in OSA patients.     

睡眠呼吸暂停低通气综合征与冠状动脉粥样硬化性心脏病关系探讨

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中冠状动脉粥样硬化性心脏病(CAD)的发病率增高,心肌缺血事件发生频繁,CAD合并OSAHS患者预后较差,OSAHS是独立于年龄、性别、体质量指数影响CAD的发病和进展的因素.OSAHS患者全身的炎性和氧化应激反应、血液流变学改变、血液动力学改变参与了CAD的发病和进展,它们之间的确切发病机制、遗传、治疗和预后将成为今后的研究热点.     

Decreased pituitary-gonadal secretion in men with obstructive sleep apnea

Decreased libido is frequently reported in male patients with obstructive sleep apnea (OSA). The decline in morning serum testosterone levels previously reported in these patients was within the normal adult male range and does not explain the frequent association of OSA and sexual dysfunction. We determined serum LH and testosterone levels every 20 min between 2200-0700 h with simultaneous sleep recordings in 10 men with sleep apnea and in 5 normal men free of any breathing disorder in sleep. The mean levels and area under the curve of LH and testosterone were significantly lower in OSA patients compared with controls [LH, 24.9 +/- 10.2 IU/liter.h vs. 43.4 +/- 9.5 (P < 0.005); testosterone, 67.2 +/- 11.5 nmol/liter.h vs. 113.3 +/- 26.8 (P < 0.003)]. Four of 10 patients had hypogonadal morning (0700 h) serum testosterone levels. Analysis of covariance (ANCOVA) revealed that the 2 groups differed significantly in the amount of LH and testosterone secreted at night independent of age or degree of obesity. After partialing out body mass index, there was a significant negative correlation between the amounts of LH and testosterone secreted at night and the respiratory distress index, but not with degree of hypoxia. Our findings suggest that OSA in men is associated with dysfunction of the pituitary-gonadal axis. The relation between LH-testosterone profiles and the severity of OSA suggests that sleep fragmentation and, to a lesser extent, hypoxia in addition to the degree of obesity and aging may be responsible for the central suppression of testosterone in these patients.     

Independent association between obstructive sleep apnea and subclinical coronary artery disease

BACKGROUND: Obstructive sleep apnea (OSA) is associated with coronary risk factors, but it is unknown if OSA is associated with development of coronary disease. We evaluated the association between OSA and the presence of subclinical coronary disease assessed by coronary artery calcification (CAC). METHODS: Consecutive patients with no history of coronary disease who underwent electron-beam CT within 3 years of polysomnography between March 1991 and December 2003 were included. OSA was defined by an apnea-hypopnea index (AHI) > or = 5 events per hour, and patients were grouped by quartiles of AHI severity. Logistic regression modeled the association between OSA severity and presence of CAC. RESULTS: There were 202 patients (70% male; median age, 50 years; mean body mass index, 32 kg/m(2); 8% diabetic; 9% current smokers; 60% hypercholesterolemic; and 47% hypertensive). OSA was present in 76%. CAC was present in 67% of OSA patients and 31% of non-OSA patients (p < 0.001). Median CAC scores (Agatston units) were 9 in OSA patients and 0 in non-OSA patients (p < 0.001). Median CAC score was higher as OSA severity increased (p for trend by AHI quartile < 0.001). With multivariate adjustment, the odds ratio for CAC increased with OSA severity. Using the first AHI quartile as reference, the adjusted odds ratios for the second, third, and fourth quartiles were 2.1 (p = 0.12), 2.4 (p = 0.06), and 3.3 (p = 0.03), respectively. CONCLUSIONS: In patients without clinical coronary disease, the presence and severity of OSA is independently associated with the presence and extent of CAC. OSA identifies patients at risk for coronary disease and may represent a highly prevalent modifiable risk factor.     

Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up

The incidence of a cardiovascular disease (CVD) was explored in a consecutive sleep clinic cohort of 182 middle-aged men (mean age, 46.8 +/- 9.3; range, 30-69 years in 1991) with or without obstructive sleep apnea (OSA). All subjects were free of hypertension or other CVD, pulmonary disease, diabetes mellitus, psychiatric disorder, alcohol dependency, as well as malignancy at baseline. Data were collected via the Swedish Hospital Discharge Register covering a 7-year period before December 31, 1998, as well as questionnaires. Effectiveness of OSA treatment initiated during the period as well as age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) at baseline, and smoking habits were controlled. The incidence of at least one CVD was observed in 22 of 60 (36.7%) cases with OSA (overnight oxygen desaturations of 30 or more) compared with in 8 of 122 (6.6%) subjects without OSA (p < 0.001). In a multiple logistic regression model, significant predictors of CVD incidence were OSA at baseline (odds ratio [OR] 4.9; 95% confidence interval [CI], 1.8-13.6) and age (OR 23.4; 95% CI, 2.7-197.5) after adjustment for BMI, SBP, and DBP at baseline. In the OSA group, CVD incidence was observed in 21 of 37 (56.8%) incompletely treated cases compared with in 1 of 15 (6.7%) efficiently treated subjects (p < 0.001). In a multiple regression analysis, efficient treatment was associated with a significant risk reduction for CVD incidence (OR 0.1; 95% CI, 0.0-0.7) after adjustment for age and SBP at baseline in the OSA subjects. We conclude that the risk of developing CVD is increased in middle-aged OSA subjects independently of age, BMI, SBP, DBP, and smoking. Furthermore, efficient treatment of OSA reduces the excess CVD risk and may be considered also in relatively mild OSA without regard to daytime sleepiness.     

Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is suspected to be an independent risk factor for atherosclerotic artery disease. The aim of this hospital-based case-control study was to assess the association between OSA and extracranial artery disease (EAD) as well as peripheral artery disease (PAD) in stroke survivors adjusting for potential confounders. METHODS: Out of 395 stroke survivors in reconvalescent phase, 235 (male 165, female 70, mean age 64.3 years, standard deviation 10.8 years) were retrospectively examined for the presence of OSA as well as EAD. Statistical analyses were then performed to detect correlations between the presence of medium to high degree artery disease (extracranial stenosis equal or higher than 50%: n=67) and the presence of severe OSA (n=58). Adjustments were made for sex, age, Barthel index and concomitant risk factors as well as body mass index and presence of dysarthria or dysphagia. Additionally, the presence of PAD (Fontaine IIa and higher: n=20) was retrospectively examined in 240 out of 395 patients. RESULTS: Severe OSA was associated independently with EAD (OR=2.0, 95%CI 1.0-4.1) and with PAD (OR=6.7, 95%CI 2.1-21.0). EAD additionally showed a stronger association with hypertension and hyperlipidemia. PAD additionally showed a strong association with smoking. CONCLUSION: Our results support the hypothesis that OSA is associated with atherosclerosis and may contribute to ischemic stroke and PAD.     

Sleepiness and nocturnal hypoxemia in Peruvian men with obstructive sleep apnea

Purpose

To evaluate the intensity of nocturnal hypoxemia associated with sleepiness in Peruvian men with a diagnosis of obstructive sleep apnea (OSA).

Methods

We carried out a secondary data analysis based on a study which includes patients with OSA who were seen in a private hospital in Lima, Peru from 2006 to 2012. We included male adults who had polysomnographic recordings and who answered the Epworth sleepiness scale (ESE). The intensity of nocturnal hypoxemia (oxygen saturation ≤90 %) was classified in four new categories: 0, <1, 1 to 10 and >10 % total sleep time with nocturnal hypoxemia (NH). When the ESE score was higher than 10, we used the definitions presence or absence of sleepiness. We used Poisson regression models with robust variance to estimate crude and adjusted prevalence ratios (PR) for association between sleepiness and NH.

Results

518 male patients with OSA were evaluated. Four hundred and fifty-two (87 %) patients had NH and 262 (51 %) had sleepiness. Of the 142 (27.4 %) patients who had >10 % total sleep time with NH, 98 (69.0 %) showed sleepiness and had a greater probability of sleepiness prevalence, with a crude PR of 1.82 (95 % CI 1.31–2.53). This association persisted in the multivariate models.

Conclusions

We found an association between NH and sleepiness. Only patients with the major intensity of NH (over 10 % of the total sleep time) had a greater probability of sleepiness. This suggests that sleepiness probably occurs after a chronic process and after overwhelming compensatory mechanisms.     

阻塞性睡眠呼吸暂停患者残余嗜睡与中枢性睡眠呼吸暂停事件的相关性

目的 探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者连续气道正压通气(continuous positive airway pressure,CPAP)治疗后残余嗜睡与中枢性睡眠呼吸暂停(central sleep apnea,CSA)事件的相关性以及匹配伺服通气(adaptive Bervo-ventilation,ASV)对CSA相关残余嗜睡的影响. 方法 选择正规使用CPAP治疗且排除其他嗜睡相关疾病的中、重度OSAS患者50例,分为残余嗜睡组(26例)和无残余嗜睡的对照组(24例).2组患者均先后接受自动CPAP治疗1个月和ASV治疗1周.分别比较2组患者治疗前、自动CPAP治疗时及ASV治疗时睡眠期的中枢性睡眠呼吸暂停指数(central sleep apnea index,CSAI),微觉醒指数(micro-arousal index,MAI)等多导睡眠监测参数及白天Epworth嗜睡评分(ESS),采用酶联免疫吸附试验测定肿瘤坏死因子a(tumor necrosis factor-a,TNF-a).两组间比较采用t检验,组内比较使用单因素方差分析,组内3个阶段两两比较采用q检验,两变量相关分析采用Pearson相关检验. 结果 治疗前2组呼吸暂停低通气指数(apnea hypoapnea index,AHI)、MAI、最低SpO2、ESS评分及血浆TNF-a水平组间比较差异没有统计学意义(t值分别为0.630、1.223、0.691、0.764和0.192,均P>0.05),但残余嗜睡组患者的CSAJ(14.39±4.21)次/h显著高于对照组[(8.58±5.75)次/h,t=4.097,P＜0.05].自动CPAP治疗1个月时2组的AHI、CSM、MAI和ESS评分均明显低于治疗前(g值为0.87～112.55,均P.＜0.05),但残余嗜睡组CSAI、MAI及ESS评分明显高于对照组[CSM:(7.19±1.75)次/h,(3.37±1.04)次/h,t=9.473,P＜O.05;MAI:(9.00±1.95)次/h,(2.36 4-0.66)次/h,f=14.385,P＜0.05;ESS:(9.54 4-0.51)分,(5.42±1.32)分,t=2.857,P＜0.05].ASV治疗时残余嗜睡组与对照组的CSAI、MAI及白天ESS评分均进一步下降,尤以残余嗜睡组的下降更为明显.此外残余嗜睡组内血浆TNF-a水平与治疗前(17.2±3.3)残余嗜睡,μg/L相比,自动CPAP治疗时(16.5 4-3.6)μg/L无明显下降(q值为11.696,P>0.05),但在ASV治疗时(12.6±3.4)μg/L与治疗前相比显著降低(q值为11.696,P＜0.05).血浆TNF-a水平与ESS评分呈显著正线性相关(r=0.503,P＜0.01),与MAI亦呈显著正相关(r=0.545,P＜0.01). 结论 经自动CPAP治疗后OSAS患者的残余嗜睡与治疗前、中存在的CSA事件频率有关.ASV在显著降低CSAI的同时也明显改善了提示ASV可有效治疗OSAS患者的残余嗜睡.TNF-a也与残余嗜睡患者的嗜睡程度相关,可能参与了残余嗜睡的发生.