睡姿对OSA患者呼吸参数的影响及健康教育思路

Influence of sleep posture on polysomnographic variables in OSA patients and corresponding health education plan

目的：探讨阻塞性睡眠呼吸暂停（ＯＳＡ）患者体位性（ＰＰ型）ＯＳＡ的患病率及ＰＰ型与非体位性（ＮＰＰ型）ＯＳＡ的临床特征。方法：回顾分析２２５例经多导睡眠仪（ＰＳＧ）检查确诊的ＯＳＡ患者ＰＰ型所占比率；比较ＰＰ型与ＮＰＰ型两组患者的一般身体特征、肺功能参数及ＰＳＧ资料，应用多元逐步回归分析探讨决定患者为ＰＰ型或ＮＰＰ型的因子。结果：２２５例ＯＳＡ患者中ＰＰ型患者共６３例（２８％）。ＰＰ型患者睡眠呼吸紊乱程度及肥胖度显著小于ＮＰＰ型组。两组年龄及肺功能参数间无显著差异。多元逐步回归分析显示，决定为ＰＰ型或ＮＰＰ型患者的主要因子为睡眠呼吸紊乱指数（ＡＨＩ）和体积指数（ＢＭＩ），两因子的预测能力为２６．２％。直线相关分析结果表明，在全组及ＮＰＰ型组患者，睡眠呼吸紊乱度与ＢＭＩ显著相关，而在ＰＰ型组，二者无相关关系。结论：约１／３的ＯＳＡ患者可归类为ＰＰ型。从理论上看，这类患者应对睡眠姿势训练治疗反应良好。区分ＰＰ与ＮＰＰ型不仅有重要的治疗意义，还有助于深入探讨ＯＳＡ的发病机制。

Objectives: To investigate the differences in clinical characteristics between obstructive sleep apnea(OSA) patients of PP type and NPP type and explore appropriate health education in those two types of patients. Methods: 225 patients were diagnosed as OSA with polysomnography(PSG),and were classified into PP type and NPP type.The demographic and PSG data were compared between the two groups.Multiple stepwise linear regressions were used to find the factors that affect sleep position dependency in OSA patients. Results: Sixtythree OSA patients were classified as PP type,others as NPP type.The value of AHI and BMI in PP patients was significantly smaller than that in NPP patients.No significant difference was found in age between the two groups.With AHI,age,BMI and SaO2 as independent variables and type(PP=0,NPP=1) as a dependent variable,AHI and BMI were found to be the predictor of sleep position dependency.Linear correlation studies showed AHI was correlated with BMI in all patients as a whole and in NPP patients,but not in PP patients. Conclusions: Sleep posture training was important in PP patients.Life style change,along with CPAP treatment and improving selfnursing ability.Differentiating PP or NPP patients was important both in nursing and treating the OSA patients.