Non-REM Apnea and Hypopnea Duration Varies across Population Groups and Physiologic Traits

Abstract

Rationale: Symptoms and morbidities associated with obstructive sleep apnea (OSA) vary across individuals and are not predicted by the apnea-hypopnea index (AHI). Respiratory event duration is a heritable trait associated with mortality that may further characterize OSA.Objectives: We evaluated how hypopnea and apnea durations in non-REM (NREM) sleep vary across demographic groups and quantified their associations with physiological traits (loop gain, arousal threshold, circulatory delay, and pharyngeal collapsibility).Methods: Data were analyzed from 1,546 participants from the Multi-Ethnic Study of Atherosclerosis with an AHI ≥5. Physiological traits were derived using a validated model fit to the polysomnographic airflow signal. Multiple linear regression models were used to evaluate associations of event duration with demographic and physiological factors.Measurements and Main Results: Participants had a mean age ± SD of 68.9 ± 9.2 years, mean NREM hypopnea duration of 21.73 ± 5.60, and mean NREM apnea duration of 23.87 ± 7.44 seconds. In adjusted analyses, shorter events were associated with younger age, female sex, higher body mass index (P < 0.01, all), and Black race (P < 0.05). Longer events were associated with Asian race (P < 0.01). Shorter event durations were associated with lower circulatory delay (2.53 ± 0.13 s, P < 0.01), lower arousal threshold (1.39 ± 0.15 s, P < 0.01), reduced collapsibility (-0.71 ± 0.16 s, P < 0.01), and higher loop gain (-0.27 ± 0.11 s, P < 0.05) per SD change. Adjustment for physiological traits attenuated age, sex, and obesity associations and eliminated racial differences in event duration.Conclusions: Average event duration varies across population groups and provides information on ventilatory features and airway collapsibility not captured by the AHI.

Keywords: MESA; epidemiology; obstructive sleep apnea; phenotype; sleep.

Figure 1.

Subject selection. AHI3% = the sum of all apneas and hypopneas, each associated with ≥3% desaturation divided by total sleep duration; CPAP = continuous positive airway pressure; MESA = Multi-Ethnic Study of Atherosclerosis.

Figure 2.

Association between NREM hypopnea duration and sample characteristics. Physiologic traits were derived from polysomnographic data. β estimates (±SE) of age (yr), male sex, body mass index (kg/m²), Asian ethnicity compared with white, and Black race compared with white are plotted after normalization of each physiologic trait. BMI = body mass index; NREM = non-REM.