| Part Ⅰ Phenotypic characteristics of patients with obstructive sleep apnea hypopnea syndrome classificated using cluster analysisObjective:To study the clinical subtypes of obstructive sleep apnea hypopnea syndrome(OSAHS)by cluster analysis,and to discuss the characteristics and clinical significance of subtypes.Methods:A retrospective analysis.Patients were diagnosed with OSAHS at the Sleeping Center of the Second Affiliated Hospital of Soochow University from January 2010 to June 2018.In this cluster analysis,16 main symptoms,7 comorbidities and 3 assessment scales were included.After selecting the best model,the parameters and characteristics of different subtypes were compared and analyzed.Results:A total of 2592 patients with complete data were included in this study.After cluster analysis,they were divided into 4 groups:sleep apnea group(1173 cases,45.3%),daytime sleepiness group(518 cases,20.0%),insomnia and memory loss group(689 cases,8.2%),and minimally symptomatic group(689cases,26.6%).In the sleep apnea group,the patients were found to be younger[(40.2±10.4)years],with higher body mass index(BMI)[(27.7±3.7)kg/m2]when compared to the other groups.In addition,the prevalence of comorbidities in this group was found to be lower,whereas the probability of sleep apnea symptom was the highest(94.7%).In daytime sleepiness group,the Epworth Sleepiness Scale(ESS)score was the highest[(12.4±5.5)points],and the probability of daytime sleepiness symptom was also found to be the highest(88.0%).In the insomnia and memory loss group,the patients were the oldest[(51.1±13.0)years],included the highest percentage of women(19.3%)and suffered the most from co-morbidities:70.3%with insomnia,88.2%with memory loss symptoms,which was the highest among all groups.In addition,the scores of short mental state scale(MMSE)and Montreal cognitive assessment(MoCA)were the lowest with a mean of[(28.5±2.4)points]and[(25.4±3.2)points],respectively.In the mild symptom group,the probability of most symptoms and comorbidities were found be the lowest.These differences in the prevalence of the main symptoms among the groups were all statistically significant(P<0.05).Symptoms like sleep apnea,daytime sleepiness,insomnia,memory loss,headache and dry mouth upon awakening were found to be significantly different in pairwise comparisons among the groups(P<0.002).Conclusion:The patients with OSAHS were divided into four clinical subtypes by cluster analysis(sleep apnea group,daytime sleepiness group,insomnia and memory loss group and minimally symptomatic group),each of which was significantly heterogeneous,providing a helpful classification to evaluate the condition and guide individualized treatment.Part Ⅱ The relationship between insomnia phenotype and mild cognitive impairment in young and middle-aged patients with obstructive sleep apnea hypopnea syndromeObjective:To explore the relationship between insomnia phenotype and mild cognitive impairment(MCI)in young and middle-aged patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:Those patients admitted due to snoring and examined by polysomnography(PSG)in the Sleep Center of the Second Affiliated Hospital of Soochow University from January 2014 to January 2019 were screened.Their cognitive function was assessed by the MoCA and their sleep quality was assessed by the Pittsburgh Sleep Quality Index(PSQI).According to the sleep apnea hypopnea index(AHI),the patients were divided into three groups:snoring group(AHI<5 times/h),mild/moderate OSAHS group(5≤AHI≤30 times/h)and severe OSAHS group(AHI>30 times/h).According to the results of PSQI score,the patients were further divided into non-insomnia group(PSQI total score<8)and insomnia group(PSQI total score≥8).The differences of parameters in different groups were compared,and the relationship between OSAHS insomnia phenotype and MCI was analyzed by binary logistic regression model.Results:A total of 2780 patients with the average age of(40.0±9.8)years old and the average BMI of(26.5±3.8)kg/m2 were enrolled in the study,including 549 cases in snoring group(including 359 cases in non-insomnia group and 190 cases in insomnia group),847 cases in mild/moderate OSAHS group(including 516 cases in non-insomnia group and 358 cases in insomnia group)and 1357 cases in severe OSAHS group(including 1118 cases in non-insomnia group and 239 cases in insomnia group).In the mild/moderate OSAHS group,compared with the non-insomnia group,the proportion of women in the insomnia group was higher(10.7 vs 17.3%)with lighter degree of obesity[BMI:(26.4±3.2)vs(25.6±3.0)kg/m2],lighter severity of illness[AHI:(17.9±7.0)vs(13.4±6.8)/h]and lighter degree of hypoxia[TS90%:(3.2±5.8)vs(2.1±3.6)%,LSaO2:(82.6±6.2)vs(84.2±7.0)%](all P<0.05).In the severe OSAHS group,the general characteristics of insomnia patients were similar to those of the mild/moderate OSAHS group,and the average age of the insomnia group was significantly higher than that of the non-insomnia group[(39.9±8.9)vs(44.0±8.9)years],and the MoCA score was lower than that of the non-insomnia group[(26.4±2.9)vs(24.9±3.4)points](all P<0.05).In the evaluation of each item of PSQI,the score of daytime dysfunction of insomnia patients in mild/moderate OSAHS group and severe OSAHS group was higher than that in snoring group[(1.3±1.0)points,(1.4±1.1)points vs(0.8±1.0)points],but the score in sleep latency was lower than that in snoring group[(1.8±1.0)points,(1.6±0.9)points vs(2.1±1.0)points](all P<0.05).After correcting the effects of OSAHS disease severity,hypoxia,education,age,gender,BMI,smoking and drinking history,the risk of MCI in insomnia group of severe OSAHS patients was significantly higher than that of non-insomnia group by 48.9%(OR=1.489,95%CI:1.068～2.077).Conclusion:Insomnia phenotype is a common clinical phenotype of OSAHS,and it is an independent risk factor for MCI in young and middle-aged patients with severe OSAHS. |
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