COMISA 患者的睡眠结构与 OSA 和失眠患者的睡眠结构比较。
Sleep structure in patients with COMISA compared to OSA and insomnia.
机构信息
Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Philips Research, Eindhoven, The Netherlands.
出版信息
J Clin Sleep Med. 2023 Jun 1;19(6):1051-1059. doi: 10.5664/jcsm.10500.
STUDY OBJECTIVES
Obstructive sleep apnea (OSA) and insomnia frequently co-occur, making diagnosis and treatment challenging. We investigated differences in sleep structure between patients with OSA, insomnia, and comorbid insomnia and sleep apnea (COMISA) to identify characteristics that can be used to improve the diagnosis of COMISA.
METHODS
We obtained polysomnography data of 326 patients from the Sleep and OSA Monitoring with Non-Invasive Applications database. The group included patients with OSA (n = 199), insomnia (n = 47), and COMISA (n = 80). We compared statistics related to sleep structure between the 3 patient groups.
RESULTS
Wake after sleep onset was significantly shorter for the OSA group (median: 60.0 minutes) compared to the COMISA (median: 83.3 minutes, < .01) and the insomnia (median: 83.5 minutes, = .01) groups. No significant differences were found in the total number of awakenings and the number of short (up to and including 2 minutes) and medium-length awakenings (2.5 up to and including 4.5 minutes). However, the number of long awakenings (5 minutes or longer) and wake after sleep onset containing only long awakenings was significantly lower for patients with OSA (median: 2 awakenings and 25.5 minutes) compared to patients with COMISA (median: 3 awakenings, < .01 and 43.3 minutes, < .001) or with insomnia (median: 3 awakenings, < .01 and 56.0 minutes, < .001). Total sleep time was significantly longer and sleep efficiency was significantly higher for the OSA group (median: 418.5 minutes and 84.4%) compared to both the COMISA (median: 391.5 minutes, < .001 and 77.3%, < .001) and the insomnia (median: 381.5 minutes, < .001 and 78.2%, < .001) groups. The number of sleep-stage transitions during the night for patients with COMISA (median: 194.0) was lower compared to that for patients with OSA (median: 218.0, < .01) and higher compared to that for patients with insomnia (median: 156.0, < .001). Other sleep architectural parameters were not discriminative between the groups.
CONCLUSIONS
Patients with COMISA show specific characteristics of insomnia, including prolonged awakenings. This variable is distinctive in comparison to patients with OSA. The combination of prolonged awakenings and the presence of sleep-disordered breathing leads to increased sleep disturbance compared to patients having only 1 of the sleep disorders.
CITATION
Wulterkens BM, Hermans LWA, Fonseca P, et al. Sleep structure in patients with COMISA compared to OSA and insomnia. . 2023;19(6):1051-1059.
研究目的
阻塞性睡眠呼吸暂停（OSA）和失眠常同时发生，这使得诊断和治疗变得具有挑战性。我们研究了 OSA、失眠和合并失眠和睡眠呼吸暂停（COMISA）患者之间的睡眠结构差异，以确定可用于改善 COMISA 诊断的特征。
方法
我们从睡眠和非侵入性应用监测中的睡眠呼吸暂停数据库中获取了 326 名患者的多导睡眠图数据。该组包括 OSA 患者（n=199）、失眠患者（n=47）和 COMISA 患者（n=80）。我们比较了 3 组患者的睡眠结构相关统计数据。
结果
与 COMISA（中位数：83.3 分钟，<0.01）和失眠（中位数：83.5 分钟，=0.01）组相比，OSA 组的睡眠起始后觉醒时间明显更短（中位数：60.0 分钟）。在总觉醒次数和短（不超过 2 分钟）和中长觉醒次数（2.5 至 4.5 分钟）方面没有发现显著差异。然而，与 COMISA 组（中位数：3 次觉醒，<0.01 和 43.3 分钟，<0.001）或失眠组（中位数：3 次觉醒，<0.01 和 56.0 分钟，<0.001）相比，OSA 组的长觉醒（5 分钟或更长）和睡眠起始后觉醒中仅含长觉醒的次数（中位数：2 次觉醒和 25.5 分钟）明显更少。与 COMISA 组（中位数：391.5 分钟，<0.001 和 77.3%，<0.001）和失眠组（中位数：381.5 分钟，<0.001 和 78.2%，<0.001）相比，OSA 组的总睡眠时间明显更长，睡眠效率明显更高（中位数：418.5 分钟和 84.4%）。与 OSA 组（中位数：218.0，<0.01）相比，COMISA 组（中位数：194.0）的夜间睡眠阶段转换次数较低，而与失眠组（中位数：156.0，<0.001）相比，COMISA 组的夜间睡眠阶段转换次数较高。各组之间的其他睡眠结构参数没有差异。
结论
COMISA 患者表现出失眠的特定特征，包括延长的觉醒。与 OSA 患者相比，这一变量具有独特性。与仅存在 1 种睡眠障碍的患者相比，延长的觉醒和存在睡眠呼吸障碍会导致睡眠障碍增加。
引文
Wulterkens BM, Hermans LWA, Fonseca P, et al. Sleep structure in patients with COMISA compared to OSA and insomnia.. 2023;19(6):1051-1059.
Zotero 插件