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

Abstract

<b>Rationale:</b> 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.<b>Objectives:</b> 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).<b>Methods:</b> 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.<b>Measurements and Main Results:</b> 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 (<i>P</i> < 0.01, all), and Black race (<i>P</i> < 0.05). Longer events were associated with Asian race (<i>P</i> < 0.01). Shorter event durations were associated with lower circulatory delay (2.53 ± 0.13 s, <i>P</i> < 0.01), lower arousal threshold (1.39 ± 0.15 s, <i>P</i> < 0.01), reduced collapsibility (-0.71 ± 0.16 s, <i>P</i> < 0.01), and higher loop gain (-0.27 ± 0.11 s, <i>P</i> < 0.05) per SD change. Adjustment for physiological traits attenuated age, sex, and obesity associations and eliminated racial differences in event duration.<b>Conclusions:</b> Average event duration varies across population groups and provides information on ventilatory features and airway collapsibility not captured by the AHI.