摘要
目的探讨重度阻塞性睡眠呼吸暂停综合征(OSAS)患者脉氧下降率与日间嗜睡的相关性。方法选择自2018年4月至2019年3月就诊于南京医科大学附属淮安第一医院睡眠医学中心打鼾患者,对其进行多导睡眠图(PSG)监测,同步行整夜连续无创血压监测。根据PSG结果以及排除标准共纳入重度OSAS患者78例。使用Epworth嗜睡量表(ESS)评分将患者分为嗜睡组(ESS>10分,40例)和非嗜睡组(ESS≤10分,38例)。采用频域分析法测量心率变异性,以低频率/高频率来反映交感神经张力。在呼吸暂停发生时,以氧减事件中每秒动脉血氧饱和度(SpO2)下降的百分比作为脉氧下降率,比较两组睡眠监测相关指标。使用多元回归方程分析导致OSAS日间嗜睡相关的指标。结果与非嗜睡组相比,嗜睡组患者更易出现严重的睡眠呼吸障碍[呼吸暂停低通气指数(AHI):(69±16)比(60±16)次/h,P=0.010;呼吸相关微觉醒指数(RERAs):(43±17)比(30±14)次/h,P=0.001]。另外,嗜睡组低氧的暴露较非嗜睡组更为严重,尤其是脉氧下降率[(0.48±0.12)%/s比(0.30±0.11)%/s,P<0.001]。回归方程显示仅有脉氧下降率与OSAS患者日间嗜睡相关(β=0.615,P<0.001)。结论脉氧下降率,作为OSAS的一个新颖睡眠监测指标,可能是OSAS白日嗜睡关键的因素之一。
Objective To investigate the correlation between oxygen desaturation rate and daytime sleepiness in patients with severe obstructive sleep apnea syndrome(OSAS).Methods Between April 2018 and March 2019,patients with snoring were enrolled from the Department of Sleep Medicine Center,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University.All subjects underwent polysomnography(PSG),and blood pressure was full-night monitored continuously and synchronized with PSG.Based on the PSG results and exclusion criteria,a total of 78 patients with severe OSAS were recruited and divided into two groups according to Epworth Sleepiness Scale(ESS):patients with excess daytime sleepiness(EDS group)(n=40,ESS>10 scores)and patients without EDS(non-EDS group)(n=38,ESS≤10 scores).Heart rate variability(HRV)was assessed in the frequency domains,the ratio of low to high frequency(LF/HF)was used to reflect sympathetic activity.Oxygen desaturation rate was expressed as the change in the percentage of pulse oxyhemoglobin saturation(SpO2)per second during an obstructive apnea event.The PSG parameters were compared between the two groups.Multiple regression analyses were used to explore the relevant indicators for EDS in severe OSAS patients.Results Compared to non-EDS group,the patients of EDS group were more likely to experience severe sleep breath disturbance[apnea-hypopnea index(AHI):(69±16)vs(60±16)events/h,P=0.010;respiratory event-related arousals(RERAs):(43±17)vs(30±14)events/h,P=0.001].In addition,hypoxia exposure conditions in the EDS group were more severe than those in the non-EDS group,especially oxygen desaturation rate[(0.48±0.12)%/s vs(0.30±0.11)%/s,P<0.001].The regression analysis showed that only the oxygen desaturation rate was correlated with the daytime sleepiness in patients with severe OSAS(β=0.615,P<0.001).Conclusion Oxygen desaturation rate,as a novel sleep monitoring parameter,may be one of the key factors associated with EDS in severe OSAS patients.
作者
谢小晨
张希龙
黄茂
陈炜
张姗
徐靖
Xie Xiaochen;Zhang Xilong;Huang Mao;Chen Wei;Zhang Shan;Xu Jing(Department of Respiratory and Critical Care Medicine,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第28期2181-2185,共5页
National Medical Journal of China
基金
国家自然科学基金(81900084)。
关键词
睡眠呼吸暂停
阻塞性
脉氧下降率
日间嗜睡
横断面研究
Sleep apnea
obstructive
Oxygen desaturation rate
Daytime sleepiness
Cross-sectional studies
