低氧負荷在評估阻塞性睡眠呼吸暫停的應用_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

張恒陽 ¹ , 譚璐 ³ ,  龔姝 ²

1. ;
2. ;
3. ;

Corresponding?author：

龔姝, Email: gdy-29@163.com

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DOI：

10.7507/1671-6205.202503034

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Citation： 張恒陽, 譚璐, 龔姝. 低氧負荷在評估阻塞性睡眠呼吸暫停的應用. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(12): 896-901. doi: 10.7507/1671-6205.202503034 Copy

1.	Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest, 2015, 147(1): 266-274.
2.	Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
3.	Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J, 2019, 40(14): 1149-1157.
4.	He S, Cook K, Sutherland K, et al. A comparison of hypoxic burden algorithms using three different methods for calculating baseline oxygen saturation for predicting cardiovascular death in the Sleep Heart Health Study. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
5.	Fietze I, Dingli K, Diefenbach K, et al. Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. Eur Respir J, 2004, 24(6): 987-993.
6.	Coso C, Solano-Pérez E, Romero-Peralta S, et al. The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review. Rev Cardiovasc Med, 2024, 25(5): 172.
7.	Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. The Lancet Respiratory Medicine. 2015, 3(4): 310-8.
8.	?aylan BK, Sara? S, Külah G, ?zol D. Determinants of MSLT- defined sleepiness in OSA patients with neuropsycological findings. Sleep Breath, 2025, 29(5): 310.
9.	Li C, Gao Y, Huang W, et al. The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome: evidence from a large cross-sectional study. Sleep Med, 2023, 111: 94-100.
10.	Karhu T, Myllymaa S, Nikkonen S, et al. Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study. Front Neurosci, 2021, 15: 657126.
11.	Yook S, Park HR, Seo D, et al. Obstructive sleep apnea subtyping based on apnea and hypopnea specific hypoxic burden is associated with brain aging and cardiometabolic syndrome. Comput Biol Med, 2025, 185: 109604.
12.	Keenan BT, Kim J, Singh B, et al. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep, 2018, 41(3): zsx214.
13.	Pinilla L, Esmaeili N, Labarca G, et al. Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a post hoc study of the ISAACC trial. Eur Respir J, 2023, 62(6): 2300828.
14.	Peker Y, Celik Y, Zinchuk A, et al. Hypoxic Burden is Associated with Cardiovascular Events: A Risk Stratification Analysis of the RICCADSA Cohort. Chest, 2025.
15.	Aishah A, Kim M, Gell L, et al. Effect of viloxazine and trazodone in obstructive sleep apnoea: a randomised, placebo-controlled, cross-over study. Thorax, 2025, 80(9): 641-649.
16.	Messineo L, Taranto-Montemurro L, Calianese N, et al. Atomoxetine and fesoterodine combination improves obstructive sleep apnoea severity in patients with milder upper airway collapsibility. Respirology, 2022, 27(11): 975-982.
17.	Schweitzer PK, Maynard JP, Wylie PE, et al. Efficacy of atomoxetine plus oxybutynin in the treatment of obstructive sleep apnea with moderate pharyngeal collapsibility. Sleep Breath, 2023, 27(2): 495-503.
18.	Rosenberg R, Abaluck B, Thein S. Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA. J Clin Sleep Med, 2022, 18(12): 2837-2844.
19.	Messineo L, Norman D, Ojile J. The combination of atomoxetine and dronabinol for the treatment of obstructive sleep apnea: a dose-escalating, open-label trial. J Clin Sleep Med, 2023, 19(7): 1183-1190.
20.	Kanu C, Shinde S, Chakladar S, et al. Effect of tirzepatide treatment on patient-reported outcomes among SURMOUNT-OSA participants with obstructive sleep apnea and obesity. Sleep Med, 2025, 134: 106719.
21.	Hellemans S, Van de Perck E, Van Loo D, et al. Acetazolamide as an Add-on Therapy Following Barbed Reposition Pharyngoplasty in Obstructive Sleep Apnea: A Randomized Controlled Trial. Life (Basel), 2024, 14(8): 963.
22.	Light M, McCowen K, Malhotra A, et al. Sleep apnea, metabolic disease, and the cutting edge of therapy. Metabolism, 2018, 84: 94-98.
23.	黃曉羽. 低氧負荷在阻塞性睡眠呼吸暫停認知損害中的作用[學位論文]. 吉林大學, 2024.
24.	Jackson CL, Umesi C, Gaston SA, et al. Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis. Thorax, 2021, 76(7): 704-13.
25.	Blanchard M, Gervès-Pinquié C, et al. Hypoxic burden and heart rate variability predict stroke incidence in sleep apnoea. Eur Respir J, 2021, 57(3): 2004022.
26.	Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J Clin Invest, 2020, 130(10): 5042-5051.
27.	Van der Touw T, Andronicos NM, Smart N. Is C-reactive protein elevated in obstructive sleep apnea? a systematic review and meta-analysis. Biomarkers, 2019, 24(5): 429-435.
28.	Imani MM, Sadeghi M, Khazaie H, et al. Evaluation of Serum and Plasma Interleukin-6 Levels in Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression. Front Immunol, 2020, 11: 1343.
29.	Cao Y, Song Y, Ning P, et al. Association between tumor necrosis factor alpha and obstructive sleep apnea in adults: a meta-analysis update. BMC Pulm Med, 2020, 20(1): 215.
30.	Imadojemu VA, Mawji Z, Kunselman A, et al. Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest, 2007, 131(5): 1406-1413.
31.	Baltzis D, Bakker JP, Patel SR, et al. Obstructive Sleep Apnea and Vascular Diseases. Compr Physiol, 2016, 6(3): 1519-1528.
32.	Carlson JT, Hedner J, Elam M, et al. Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest, 1993, 103(6): 1763-1768.
33.	Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
34.	Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA, 2000, 283(14): 1829-1836.
35.	Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19): 1378-1384.
36.	Zhang H, Liu H, Jiao Y, et al. Association between sleep apnea-specific hypoxic burden and severity of coronary artery disease. Sleep Breath, 2024, 28(3): 1293-1301.
37.	Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation, 2010, 122(4): 3523260.
38.	Kim JS, Azarbarzin A, Wang R, Zee PC, et al. Association of novel measures of sleep disturbances with blood pressure: the Multi-Ethnic Study of Atherosclerosis. Thorax, 2020, 75(1): 57-63.
39.	Azarbarzin A, Sands SA, Taranto-Montemurro L, et al. The sleep apnea-specific hypoxic burden predicts incident heart failure. Chest, 2020, 158(2): 739-750.
40.	Real EB, Signes-Costa J, Gavara J, et al. Hypoxic burden and angiogenic factors in patients with myocardial infarction and obstructive sleep apnea. Eur Respir J, 2019, 54(Sup63): 3.
41.	Peker Y, Zinchuk A, Celik Y, et al. Hypoxic Burden but Not AHI Predicts Risk of Cardiovascular Events: A Secondary Analysis of the RICCADSA Clinical Trial. B99 SLEEP APNEA UNPLUGGED: NAVIGATING A MYRIAD OF HEALTH OUTCOMES: American Thoracic Society, 2024. p. A4730-A.
42.	Trzepizur W, Blanchard M, Ganem T, et al. Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality. Am J Respir Crit Care Med, 2022, 205(1): 108-117.
43.	Malhotra A, White DP. Obstructive sleep apnoea. The lancet, 2002, 360(9328): 237-45.
44.	Valencia-Flores M, Orea A, Casta?o VA, et al. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res, 2000, 8(3): 262-269.
45.	Martínez-Cerón E, Casitas R, Galera R, et al. Contribution of sleep characteristics to the association between obstructive sleep apnea and dyslipidemia. Sleep Med, 2021, 84: 63-72.
46.	Meszaros M, Bikov A. Obstructive sleep apnoea and lipid metabolism: the summary of evidence and future perspectives in the pathophysiology of OSA-associated dyslipidaemia. Biomedicines, 2022, 10(11): 2754.
47.	Polak J, Shimoda LA, Drager LF, et al. Intermittent hypoxia impairs glucose homeostasis in C57BL6/J mice: partial improvement with cessation of the exposure. Sleep, 2013, 36(10): 1483-90.
48.	Iiyori N, Alonso LC, Li J, et al. Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med, 2007, 175(8): 851-857.
49.	Uataya M, Banhiran W, Chotinaiwattarakul W, et al. Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea. Sleep and Breathing, 2023, 27(6): 2423-2428.
50.	Li C, Peng Y, Zhu X, Liu Y, Zou J, Zhu H, et al. Independent relationship between sleep apnea-specific hypoxic burden and glucolipid metabolism disorder: a cross-sectional study. Respir Res. 2024, 25(1): 214.
51.	Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res. 2015, 93(12): 1778-1794.
52.	Hajipour M, Hu WH, Esmaeili N, et al. Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis. J Clin Sleep Med, 2025, 21(3): 457-66.
53.	Zhou Y, Shi Y, Zhu S, et al. Independent Association of Sleep Apnea-Specific Hypoxic Burden and Sleep Breathing Impairment Index with Thyroid Function in Obstructive Sleep Apnea: A Retrospective Study. Nat Sci Sleep, 2025, 17: 1543-1556.
54.	Orr JE, Bosompra NO, Norby B, et al. Chronic pain is associated with sleep apnea severity but attenuated by intermittent hypoxemia in people using opioids. Pain. 2025 Jul 24: 10.1097/j. pain. 0000000000003760.
55.	Kovbasyuk Z, Ramos-Cejudo J, Parekh A, et al. Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk. J Am Heart Assoc. 2024, 13(15): e034079.
56.	Zhu S, Zhou Y, Lu C, et al. Effectiveness of the sleep apnea-specific hypoxic burden and sleep breathing impairment index in assessing cognitive impairment in children with obstructive sleep apnea. Front Pediatr, 2025, 13: 1628961.
57.	Bokov P, Dudoignon B, Delclaux C. Hypoxic burden as a cause of cardiovascular morbidity in childhood obstructive sleep apnea. Pediatr Res. 2025, May 23. doi: 10.1038/s41390-025-04153-3. Epub ahead of print.
58.	Bokov P, Dudoignon B, Delclaux C. Hypoxic Burden in Children With Sleep-Disordered Breathing: Determinants and Correlates. J Sleep Res. 2025 Sep 20: e70211. doi: 10.1111/jsr.70211. Epub ahead of print.
59.	Ni YN, Lei F, Tang X, et al. Sleep apnea-related hypoxic burden as a predictor of pregnancy and neonatal outcome. Sleep Med. 2024, 119: 432-437.

1. Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest, 2015, 147(1): 266-274.
2. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
3. Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J, 2019, 40(14): 1149-1157.
4. He S, Cook K, Sutherland K, et al. A comparison of hypoxic burden algorithms using three different methods for calculating baseline oxygen saturation for predicting cardiovascular death in the Sleep Heart Health Study. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
5. Fietze I, Dingli K, Diefenbach K, et al. Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. Eur Respir J, 2004, 24(6): 987-993.
6. Coso C, Solano-Pérez E, Romero-Peralta S, et al. The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review. Rev Cardiovasc Med, 2024, 25(5): 172.
7. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. The Lancet Respiratory Medicine. 2015, 3(4): 310-8.
8. ?aylan BK, Sara? S, Külah G, ?zol D. Determinants of MSLT- defined sleepiness in OSA patients with neuropsycological findings. Sleep Breath, 2025, 29(5): 310.
9. Li C, Gao Y, Huang W, et al. The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome: evidence from a large cross-sectional study. Sleep Med, 2023, 111: 94-100.
10. Karhu T, Myllymaa S, Nikkonen S, et al. Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study. Front Neurosci, 2021, 15: 657126.
11. Yook S, Park HR, Seo D, et al. Obstructive sleep apnea subtyping based on apnea and hypopnea specific hypoxic burden is associated with brain aging and cardiometabolic syndrome. Comput Biol Med, 2025, 185: 109604.
12. Keenan BT, Kim J, Singh B, et al. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep, 2018, 41(3): zsx214.
13. Pinilla L, Esmaeili N, Labarca G, et al. Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: a post hoc study of the ISAACC trial. Eur Respir J, 2023, 62(6): 2300828.
14. Peker Y, Celik Y, Zinchuk A, et al. Hypoxic Burden is Associated with Cardiovascular Events: A Risk Stratification Analysis of the RICCADSA Cohort. Chest, 2025.
15. Aishah A, Kim M, Gell L, et al. Effect of viloxazine and trazodone in obstructive sleep apnoea: a randomised, placebo-controlled, cross-over study. Thorax, 2025, 80(9): 641-649.
16. Messineo L, Taranto-Montemurro L, Calianese N, et al. Atomoxetine and fesoterodine combination improves obstructive sleep apnoea severity in patients with milder upper airway collapsibility. Respirology, 2022, 27(11): 975-982.
17. Schweitzer PK, Maynard JP, Wylie PE, et al. Efficacy of atomoxetine plus oxybutynin in the treatment of obstructive sleep apnea with moderate pharyngeal collapsibility. Sleep Breath, 2023, 27(2): 495-503.
18. Rosenberg R, Abaluck B, Thein S. Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA. J Clin Sleep Med, 2022, 18(12): 2837-2844.
19. Messineo L, Norman D, Ojile J. The combination of atomoxetine and dronabinol for the treatment of obstructive sleep apnea: a dose-escalating, open-label trial. J Clin Sleep Med, 2023, 19(7): 1183-1190.
20. Kanu C, Shinde S, Chakladar S, et al. Effect of tirzepatide treatment on patient-reported outcomes among SURMOUNT-OSA participants with obstructive sleep apnea and obesity. Sleep Med, 2025, 134: 106719.
21. Hellemans S, Van de Perck E, Van Loo D, et al. Acetazolamide as an Add-on Therapy Following Barbed Reposition Pharyngoplasty in Obstructive Sleep Apnea: A Randomized Controlled Trial. Life (Basel), 2024, 14(8): 963.
22. Light M, McCowen K, Malhotra A, et al. Sleep apnea, metabolic disease, and the cutting edge of therapy. Metabolism, 2018, 84: 94-98.
23. 黃曉羽. 低氧負荷在阻塞性睡眠呼吸暫停認知損害中的作用[學位論文]. 吉林大學, 2024.
24. Jackson CL, Umesi C, Gaston SA, et al. Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis. Thorax, 2021, 76(7): 704-13.
25. Blanchard M, Gervès-Pinquié C, et al. Hypoxic burden and heart rate variability predict stroke incidence in sleep apnoea. Eur Respir J, 2021, 57(3): 2004022.
26. Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J Clin Invest, 2020, 130(10): 5042-5051.
27. Van der Touw T, Andronicos NM, Smart N. Is C-reactive protein elevated in obstructive sleep apnea? a systematic review and meta-analysis. Biomarkers, 2019, 24(5): 429-435.
28. Imani MM, Sadeghi M, Khazaie H, et al. Evaluation of Serum and Plasma Interleukin-6 Levels in Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression. Front Immunol, 2020, 11: 1343.
29. Cao Y, Song Y, Ning P, et al. Association between tumor necrosis factor alpha and obstructive sleep apnea in adults: a meta-analysis update. BMC Pulm Med, 2020, 20(1): 215.
30. Imadojemu VA, Mawji Z, Kunselman A, et al. Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest, 2007, 131(5): 1406-1413.
31. Baltzis D, Bakker JP, Patel SR, et al. Obstructive Sleep Apnea and Vascular Diseases. Compr Physiol, 2016, 6(3): 1519-1528.
32. Carlson JT, Hedner J, Elam M, et al. Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest, 1993, 103(6): 1763-1768.
33. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
34. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA, 2000, 283(14): 1829-1836.
35. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000, 342(19): 1378-1384.
36. Zhang H, Liu H, Jiao Y, et al. Association between sleep apnea-specific hypoxic burden and severity of coronary artery disease. Sleep Breath, 2024, 28(3): 1293-1301.
37. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation, 2010, 122(4): 3523260.
38. Kim JS, Azarbarzin A, Wang R, Zee PC, et al. Association of novel measures of sleep disturbances with blood pressure: the Multi-Ethnic Study of Atherosclerosis. Thorax, 2020, 75(1): 57-63.
39. Azarbarzin A, Sands SA, Taranto-Montemurro L, et al. The sleep apnea-specific hypoxic burden predicts incident heart failure. Chest, 2020, 158(2): 739-750.
40. Real EB, Signes-Costa J, Gavara J, et al. Hypoxic burden and angiogenic factors in patients with myocardial infarction and obstructive sleep apnea. Eur Respir J, 2019, 54(Sup63): 3.
41. Peker Y, Zinchuk A, Celik Y, et al. Hypoxic Burden but Not AHI Predicts Risk of Cardiovascular Events: A Secondary Analysis of the RICCADSA Clinical Trial. B99 SLEEP APNEA UNPLUGGED: NAVIGATING A MYRIAD OF HEALTH OUTCOMES: American Thoracic Society, 2024. p. A4730-A.
42. Trzepizur W, Blanchard M, Ganem T, et al. Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality. Am J Respir Crit Care Med, 2022, 205(1): 108-117.
43. Malhotra A, White DP. Obstructive sleep apnoea. The lancet, 2002, 360(9328): 237-45.
44. Valencia-Flores M, Orea A, Casta?o VA, et al. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res, 2000, 8(3): 262-269.
45. Martínez-Cerón E, Casitas R, Galera R, et al. Contribution of sleep characteristics to the association between obstructive sleep apnea and dyslipidemia. Sleep Med, 2021, 84: 63-72.
46. Meszaros M, Bikov A. Obstructive sleep apnoea and lipid metabolism: the summary of evidence and future perspectives in the pathophysiology of OSA-associated dyslipidaemia. Biomedicines, 2022, 10(11): 2754.
47. Polak J, Shimoda LA, Drager LF, et al. Intermittent hypoxia impairs glucose homeostasis in C57BL6/J mice: partial improvement with cessation of the exposure. Sleep, 2013, 36(10): 1483-90.
48. Iiyori N, Alonso LC, Li J, et al. Intermittent hypoxia causes insulin resistance in lean mice independent of autonomic activity. Am J Respir Crit Care Med, 2007, 175(8): 851-857.
49. Uataya M, Banhiran W, Chotinaiwattarakul W, et al. Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea. Sleep and Breathing, 2023, 27(6): 2423-2428.
50. Li C, Peng Y, Zhu X, Liu Y, Zou J, Zhu H, et al. Independent relationship between sleep apnea-specific hypoxic burden and glucolipid metabolism disorder: a cross-sectional study. Respir Res. 2024, 25(1): 214.
51. Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res. 2015, 93(12): 1778-1794.
52. Hajipour M, Hu WH, Esmaeili N, et al. Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis. J Clin Sleep Med, 2025, 21(3): 457-66.
53. Zhou Y, Shi Y, Zhu S, et al. Independent Association of Sleep Apnea-Specific Hypoxic Burden and Sleep Breathing Impairment Index with Thyroid Function in Obstructive Sleep Apnea: A Retrospective Study. Nat Sci Sleep, 2025, 17: 1543-1556.
54. Orr JE, Bosompra NO, Norby B, et al. Chronic pain is associated with sleep apnea severity but attenuated by intermittent hypoxemia in people using opioids. Pain. 2025 Jul 24: 10.1097/j. pain. 0000000000003760.
55. Kovbasyuk Z, Ramos-Cejudo J, Parekh A, et al. Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk. J Am Heart Assoc. 2024, 13(15): e034079.
56. Zhu S, Zhou Y, Lu C, et al. Effectiveness of the sleep apnea-specific hypoxic burden and sleep breathing impairment index in assessing cognitive impairment in children with obstructive sleep apnea. Front Pediatr, 2025, 13: 1628961.
57. Bokov P, Dudoignon B, Delclaux C. Hypoxic burden as a cause of cardiovascular morbidity in childhood obstructive sleep apnea. Pediatr Res. 2025, May 23. doi: 10.1038/s41390-025-04153-3. Epub ahead of print.
58. Bokov P, Dudoignon B, Delclaux C. Hypoxic Burden in Children With Sleep-Disordered Breathing: Determinants and Correlates. J Sleep Res. 2025 Sep 20: e70211. doi: 10.1111/jsr.70211. Epub ahead of print.
59. Ni YN, Lei F, Tang X, et al. Sleep apnea-related hypoxic burden as a predictor of pregnancy and neonatal outcome. Sleep Med. 2024, 119: 432-437.

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