摘要
目的:探讨伴有日间过度嗜睡(EDS)的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床特征及EDS的危险因素。方法:入选413例经整夜多导睡眠(PSG)监测确诊的OSAHS患者,根据Epworth嗜睡评分(ESS)将患者分为有EDS组(ESS≥11)和无EDS组(ESS≤10),比较2组的临床特征和PSG结果,用多因素分析探讨EDS的独立危险因素。结果:与无EDS组比,有EDS组患者同时主诉夜间憋醒(51.8%vs.36%)、晨起头痛(25.5%vs.11%)、记忆力下降(72.3%vs.54.8%)、生活受影响(50.4%vs.35.3%)、工作受影响(47.5%vs.19.5%)和交通受影响(24.8%vs.9.6%)的比例较高;微觉醒指数(MAI)(50.72±21.20 vs.39.43±19.50)和呼吸暂停低通气指数(AHI)(56.18±22.74 vs.35.21±23.04)更高,最长呼吸暂停时间[(66.60±29.24)s vs.(55.05±25.01)s]更长,夜间最低SpO2[(63.96±16.85)%vs.(74.04±12.27)%]和平均SpO2[(91.25±4.55)%vs.(93.92±2.62)%]更低,氧减饱和指数(ODI)(57.89±24.10 vs.36.34±24.12)更高,夜间氧饱和度小于90%的时间(SIT90)(14.5%vs.4.3%)更长。多因素分析提示,晨起头痛[OR(95%CI)=3.809(1.704~8.514)]、记忆力下降[OR(95%CI)=1.914(1.002~3.654)]、日常工作[OR(95%CI)=3.445(1.772~6.698)]和交通[OR(95%CI)=2.468(1.061~5.738)]受影响与EDS独立相关,MAI[OR(95%CI)=1.030(1.015~1.045)]、AHI[OR(95%CI)=1.043(1.006~1.081)]和SIT90[OR(95%CI)=1.038(1.018~1.058)]均为EDS的独立危险因素。结论:有EDS的OSAHS患者与无EDS的患者比有更多的合并症状。睡眠片段化、AHI和夜间低氧均为EDS的独立危险因素。
Objective:To investigate the clinical characteristics in patients with obstructive sleep apneahypopnea syndrome(OSAHS)and excessive daytime sleepiness(EDS)and the possible risk factors of EDS.Methods:A total of 413 OSAHS patients were assigned to the EDS or the non-EDS group according to the Epworth sleepiness scores.Univariate and multivariate analysis was conducted on clinical features and polysomnographic variables.Results:The incidences of gasping/choking(51.8%vs.36%),morning headache(25.5%vs.11%),and memory loss(72.3%vs.54.8%)were higher in the EDS group.A higher percentage of patients in the EDS group complained life(50.4%vs.35.3%),work(47.5%vs.19.5%)and commute(24.8%vs.9.6%)disturbance.The micro-arousal index(MAI)(50.72±21.20 vs.39.43±19.50),apnea hypopnea index(AHI)(56.18±22.74 vs.35.21±23.04),the longest time of apnea[(66.60±29.24)s vs.(55.05±25.01)s],oxygen desaturation index(ODI)(57.89±24.10 vs.36.34±24.12)and the saturation impair time below 90%(SIT90)(14.5%vs.4.3%)were higher or longer in the EDS group.The nadir[(63.96±16.85)%vs.(74.04±12.27)%]and mean nocturnal SpO2[(91.25±4.55)%vs.(93.92±2.62)%]was lower in the EDS group.Multivariate analysis showed morning headache[OR(95%CI)=3.809(1.704-8.514)],memory loss[OR(95%CI)=1.914(1.002-3.654)],work[OR(95%CI)=3.445(1.772-6.698)]and commute disturbances[OR(95%CI)=2.468(1.061-5.738)]were independently associated with EDS,and the MAI[OR(95%CI)=1.030(1.015-1.045)],AHI[OR(95%CI)=1.043(1.006-1.081)]and SIT90[OR(95%CI)=1.038(1.018-1.058)]were independent risk factors of EDS.Conclusion:OSAHS patients with EDS have more comorbid symptoms than those without EDS.Sleep fragmentation,AHI and nocturnal hypoxia are independent risk factors for EDS.
作者
邵川
方卿
陈益女
屠金晶
SHAO Chuan;FANG Qing;CHEN Yinyu;TU Jinjing(Department of Respiratory and Critical Care Medicine,Ningbo Medical Center Lihuili Hospital,Ningbo 315040,China)
出处
《温州医科大学学报》
CAS
2021年第2期118-122,共5页
Journal of Wenzhou Medical University
基金
宁波市医学科技计划项目(2019Y01)。
