Nature and Science of Sleep (Apr 2021)

Model for Identifying High Carotid Body Chemosensitivity in Patients with Obstructive Sleep Apnea

  • Li HP,
  • Wang HQ,
  • Li N,
  • Zhang L,
  • Li SQ,
  • Yan YR,
  • Lu HH,
  • Wang Y,
  • Sun XW,
  • Lin YN,
  • Zhou JP,
  • Li QY

Journal volume & issue
Vol. Volume 13
pp. 493 – 501

Abstract

Read online

Hong Peng Li,1,2,* Hai Qin Wang,3,* Ning Li,1,2,* Liu Zhang,1,2 Shi Qi Li,1,2 Ya Ru Yan,1,2 Huan Huan Lu,1,2 Yi Wang,1,2 Xian Wen Sun,1,2 Ying Ni Lin,1,2 Jian Ping Zhou,1,2 Qing Yun Li1,2 1Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China; 2Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China; 3Xietu Community Health Service Center of Xuhui District, Shanghai, 200231, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing Yun LiDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai 200025, PR China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, No. 197 Rui Jin 2nd Road, Shanghai, 200025, People’s Republic of ChinaTel +86-21-64370045Fax +86-21-62836805Email [email protected]: The carotid body (CB) is a major peripheral respiratory chemoreceptor. In patients with obstructive sleep apnea (OSA), high CB chemosensitivity (CBC) is associated with refractory hypertension and insulin resistance and known to further aggravate OSA. Thus, the identification of high CB (hCBC) among OSA patients is of clinical significance, but detection methods are still limited. Therefore, this study aimed to explore the association of CBC with OSA severity and to develop a simplified model that can identify patients with hCBC.Methods: In this cross-sectional study of subjects who underwent polysomnography (PSG), CBC was measured using the Dejours test. We defined hCBC as a decrease of > 12% in respiratory rate (RR) after breathing of pure O2. The association of CBC with OSA severity was explored by logistic regression, and a model for identifying hCBC was constructed and confirmed using receiver operating characteristic analysis.Results: Patients with OSA (n=142) and individuals without OSA (n=38) were enrolled. CBC was higher in patients with OSA than in those without OSA (% decrease in RR, 15.2%± 13.3% vs 9.1%± 7.5%, P< 0.05). Apnea-hypopnea index (AHI), fraction of apnea-hypopnea events in rapid-eye-movement sleep (Fevents-in-REM), and longest time of apnea (LTA) were associated with hCBC independently (odds ratio [OR]=1.048, OR=1.082, and OR=1.024 respectively; all P< 0.05). The model for identifying hCBC allocated a score to each criterion according to its OR values, ie, 1 (LTA > 48.4 s), 2 (AHI > 15.7 events/hour), and 3 (Fevents-in-REM > 12.7%). A score of 3 or greater indicated hCBC with a sensitivity of 79.4% and specificity of 88.2%.Conclusion: High CBC is associated with the severity of OSA. A simplified scoring system based on clinical variables from PSG can be used to identify hCBC.Keywords: carotid body, chemosensitivity, obstructive sleep apnea, severity, indicator

Keywords