经鼻持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构近远期的影响

Short-term and long-term influences of nasal continuous positive airway pressure to sleep architecture of obstructive sleep apnea hypopnea syndrome

目的 观察经鼻持续气道正压 (nCPAP)通气对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠结构近远期的影响。方法 17例对照者行多导睡眠图 (PSG)监测 ,对 30例经PSG诊断的OSAHS患者行nCPAP治疗 ,治疗第 1夜行PSG监测 ,连续家庭nCPAP治疗 6个月后行第 2次PSG监测 ,分析比较睡眠结构的变化。结果 OSAHS患者治疗前睡眠转换次数、1期、2期睡眠比例较对照组增加 (P <0 0 5 ) ,慢波睡眠期、快动眼 (REM )期比例较对照组低 (P <0 0 5 ) ;nCPAP治疗第 1夜睡眠转换次数、1期、2期睡眠比例较治疗前降低 (P <0 0 5 ) ,慢波睡眠期、REM期比例较治疗前升高 (P <0 0 5 ) ;nCPAP治疗 6个月后睡眠转换次数、1期、2期、慢波睡眠期比例与治疗第 1夜比较差异均无显著性 (P >0 0 5 ) ,而REM期比例较治疗第 1夜降低 (P <0 0 5 )。结论 OSAHS患者睡眠转换次数明显增多 ,1期睡眠增加而REM期睡眠减少 ,睡眠结构紊乱。nCPAP治疗第 1夜及6个月后睡眠结构得到有效纠正 ,是OSAHS长期有效的治疗方法之一。

Objective To observe the short-term and long-term influences of nasal continuous positive airway pressure (nCPAP) to sleep architecture of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Thirty cases who were diagnosed as OSAHS patients by polysomnagrphy (PSG) were enrolled in the study. They received the nCPAP treatment in hospital at first night and then at home. Seventeen healthy adults were enrolled as control group and experienced PSG monitoring and recording. The sleep architectures of control group and OSAHS group( before nCPAP, first night on the nCPAP and 6 months after continuous nCPAP treatment) were analysed. Results The sleep shift number, first stage sleep, second stage sleep, stage of slow wave sleep and stage of rapid eye movement (REM) sleep were 34.41±10.16,(5.95±3.89)%,(48.13±7.68)%,(18.30±4.71)%, and(26.83±6.65)%, respectively, in control group. These parameters in OSAHS group before nCPAP were 207.30±149.80,(21.42±10.17)%,(55.24±13.28)%,(15.38±19.57)%, and(10.15±7.82)%,respectively. At the first night of nCPAP treatment they were 55.77±25.04,(10.92±9.62)%,(50.19±13.34)%,(17.53±10.06)%, and(21.17±7.66)%, respectively. There were statistically significant differences between the PSG parameters before and after nCPAP treatment in OSAHS group(P<0.05). After 6 months of nCPAP treatment, the stage of REM sleep was significantly shorter(P<0.05), but the other parameters had no significant changes compared with those at the first night on nCPAP(P>0.05). Conclusion The sleep shift number and first stage sleep in OSAHS group were significantly increased , but the stage of REM sleep was significantly decreased than those in control group. The sleep architecture of OSAHS was significantly improved when the nCPAP treatment was given continuously.