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Implication of mixed sleep apnea events in adult patients with obstructive sleep apnea-hypopnea syndrome



Although mixed sleep apnea (MSA) is one of the three types of sleep apnea, it is not considered a separate disease entity. It is generally seen as a part of obstructive sleep apnea-hypopnea syndrome (OSAHS), but its implications are often ignored. In this study, we examined its features and the potential impact on OSAHS patients.


Subjects diagnosed with OSAHS by polysomnography (PSG) were enrolled. All participants underwent physical checkups and tests of blood biochemistry. They were anthropometrically, clinically, and polysomnographically studied.


MSA events were common in patients with severe OSAHS patients. There were significant differences between the pure OSAHS group and its mixed counterpart in apnea-hypopnea indices during REM (AHIREM) and non-REM (AHINREM) and in percentages of N2 or N3 sleep. Logistic regression analysis showed that, after adjustment of other parameters, patients with MSA events were mostly male, had higher body mass index (BMI), higher scores on Epworth Sleepiness Scales (ESS), higher triglyceride (TG) levels, and higher apnea-hypopnea index (AHI). The combined predictive probability of the aforementioned variables was 0.766 (95% CI = 0.725~0.806; sensitivity 61.6%, specificity 82.1%).


Our study suggested that MSA was related to the stability of the ventilatory control in OSAHS patients. MSA events occur more frequently in patients with severe OSAHS, and male gender, obesity, daytime sleepiness, and elevated TG levels were risk factors for the mixed OSAHS.

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We are indebted to all the subjects who took part in this study and the staff of the Sleep Center of Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.


This work is supported by the National Natural Science Foundation of China (81570903).

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Correspondence to Xiong Chen.

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The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yang, X., Xiao, Y., Han, B. et al. Implication of mixed sleep apnea events in adult patients with obstructive sleep apnea-hypopnea syndrome. Sleep Breath 23, 559–565 (2019).

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  • Obstructive sleep apnea
  • Mixed sleep apnea
  • Mixed sleep apnea events
  • Clinical and polysomnographic features