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. 2024 Jan 8:14:1191233.
doi: 10.3389/fneur.2023.1191233. eCollection 2023.

Assessing the contribution of mild high-altitude exposure to obstructive sleep apnea-hypopnea syndrome comorbidities

Lijuan Hao  1 , Kangkang Peng  1 , Qi Bian  2 , Suting Guo  2 , Chengmin Duan  1 , Lei Feng  1 , Zhenguo Chen  1 , Caiang Renzeng  1 , Huaixia Pang  1 , Zhen Ma  1
Affiliations

Assessing the contribution of mild high-altitude exposure to obstructive sleep apnea-hypopnea syndrome comorbidities

Lijuan Hao et al. Front Neurol. .

Abstract

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder. The lower atmospheric pressure and decreased oxygen levels of high-altitude areas can exacerbate the severity of OSAHS, but research into OSAHS in high-altitude areas remains limited. This study, from June 2015 to January 2020, involved 4,667 patients with suspected OSAHS and 38 healthy volunteers. The non-OSAHS group (AHI <5/h) had 395 patients, while the larger OSAHS group (AHI ≥5/h) comprised 4,272 patients. The significant size difference between the groups emphasized the study's focus on OSAHS, using the non-OSAHS mainly for comparison.

Methods: Sleep technicians monitored the OSAHS patient group overnight by polysomnography (PSG), the apnea-hypopnea index (AHI), the mean oxygen saturation (MSpO2), lowest oxygen saturation (LSpO2), the oxygen desaturation index (ODI) and the total sleep time with oxygen saturation less than 90% (TST-SpO2 <90%). Healthy volunteers self-monitored sleep patterns at home, using the CONTEC RS01 respiration sleep monitor with a wristwatch sleep apnea screen meter. The RSO1 wristwatch-style device has already been studied for consistency and sensitivity with the Alice-6 standard multi-lead sleep monitor and can be used for OSAHS screening in this region.

Results: LSpO2 recordings from healthy volunteers (86.36 ± 3.57%) and non-OSAHS (AHI <5/h) cohort (78.59 ± 11.99%) were much lower than previously reported normal values. Regression analysis identified no correlations between AHI levels and MSpO2 or TST-SpO2 <90%, weak correlations between AHI levels and LSpO2 or MSpO2, and a strongly significant correlation between AHI levels and the ODI (r = 0.76, p < 0.05). The data also indicated that the appropriate clinical thresholds for OSAHS patients living at mild high altitude are classified as mild, moderate, or severe based on LSpO2 saturation criteria of 0.85-0.90, 0.65-0.84, or <0.65, respectively.

Conclusion: The study findings suggest that individuals with an AHI score below 5 in OSAHS, who reside in high-altitude areas, also require closer monitoring due to the elevated risk of nocturnal hypoxia. Furthermore, the significant correlation between ODI values and the severity of OSAHS emphasizes the importance of considering treatment options. Additionally, the assessment of hypoxemia severity thresholds in OSAHS patients living in high-altitude regions provides valuable insights for refining diagnostic guidelines.

Keywords: apnea; hyponea treatment; mild high altitude; obstructive sleep apnea-hypopnea syndrome; oxygen desaturation index.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The oxygen saturation values defined as normal in previous publications, with the means for the healthy volunteers and non-OSAHS group in this study. (A) The oxygen saturation values of the healthy volunteer group. (B) The mean and lowest oxygen saturation values among the sea level, healthy volunteer, and non-OSAHS groups. SpO2 = oxygen saturation, how much oxygen the blood is carrying as a percentage of the maximum it can carry. MSpO2 = mean oxygen saturation, the average level of oxygen saturation during a specified period; LSpO2 = lowest oxygen saturation, the lowest recorded oxygen saturation level during the observation period, indicating the severity of respiratory disruptions. Descriptive statistics for the data were presented as mean ± standard deviation (SD) and the SD values were visually represented using error bars. Statistically significant results are denoted with an asterisk(*), with *p < 0.05, **p < 0.01, and ***p < 0.001 indicating the significance levels.
Figure 2
Figure 2
Receiver operating characteristic curve (ROC) analysis of MSpO2, LSpO2, TST-SpO2 <90% and ODI values at (A) AHI ≥ 5 to < 15/h, (B) AHI ≥ 15 to < 30/h, and (C) AHI ≥ 30/h.
Figure 3
Figure 3
Regression analysis of correlations between AHI levels and (A) ODI, (B) LSpO2, (C) MSpO2 and (D) TST-SpO2 <90% values. Every data point corresponds to an individual participant.
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Grants and funding

This work was supported by the Science and Technology Department of Qinghai Province, China (2017-ZJ-Y03 and 2019-HZ-811).

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