长期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质量的改善作用

Improving effect of longterm nasal continuous positive airway pressure therapy on quality of sleep in patients with obstructive sleep apnea/hypopnea syndrome

目的:阻塞性睡眠呼吸暂停低通气综合征可引起高血压与睡眠分裂。长期经鼻持续气道正压通气治疗是否可改善通气功能、睡眠质量,并能够降低继发性高血压?方法:选择1997-07/2004-03在福建医科大学附属第一医院呼吸科鼾症工作室明确诊断患有阻塞性睡眠呼吸暂停低通气综合征,并能坚持在家长期使用经鼻持续气道正压通气治疗的患者66例。患者呼吸紊乱指数>20,即均为中、重度患者。携带经鼻持续气道正压通气呼吸机回家,每晚使用≥6h,应用12～34个月。观察患者治疗前、治疗时及治疗后睡眠时最低动脉血氧饱和度,睡前及清晨血压,低通气指数,呼吸暂停指数,呼吸紊乱指数及最长呼吸暂停时间,并调查治疗前后Epworth评分(根据患者嗜睡出现频率:从不嗜睡0分,偶尔嗜睡1分,有时嗜睡2分,经常嗜睡3分的积分判断嗜睡程度)及匹兹堡睡眠质量指数(包括睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、安眠药物和日间功能,每个成分按0,1,2,3计分,各域分相加为总分越高示睡眠质量越差)。治疗时对患者随访3年。结果:按意向处理分析,3年随访,66例患者均进入结果分析。①Epworth评分和匹兹堡睡眠质量指数:治疗后明显低于治疗前[(7.54±2.21),(2.85±1.56)分,(13.67±4.72),(8.61±3.75)分,P<0.01]。②多导睡眠图监测参数:治疗后低通气指数、呼吸暂停指数、呼吸紊乱指数、最长呼吸暂停时间均较治疗前改善(P<0.05)。③最低血氧饱和度:治疗时和治疗后均明显高于治疗前(P<0.05),尤以治疗时明显(P<0.05);治疗后明显低于治疗时(P<0.05)。④血压:治疗后明显低于治疗前(P<0.05)。结论:长期坚持经鼻持续气道正压通气治疗,可以显著改善中、重度阻塞性睡眠呼吸暂停低通气综合征患者的睡眠质量,消除睡眠时呼吸暂停和低通气,纠正夜间低氧血症,治疗因阻塞性睡眠呼吸暂停低通气综合征所引起的高血压。

AIM: Obstructive sleep apnea/hypopnea syndrome(OSAHS) can cause hypertension and sleep split. Whether longterm nasal continuous positive airway pressure therapy can improve ventilation function and sleep quality and decrease secondary hypertension or not*9芽 METHODS: From July 1997 to March 2004, 66 patients who were diagnosed with OSAHS were recruited from Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University. They can persist in treating with longterm nasal continuous positive airway pressure at home. respiratory disturbance index of the patients > 20, those were moderate, severe patients. They took nasal continuous positive airway pressure Respirator home, using it more than 6 hours every evening for consecutively 12 to 34 months. The lowest arterial oxygen saturation of the patients when sleeping was observed before therapy, during the therapy and after therapy. The blood pressure before and after sleep , the low ventilation index , apnea index , respiratory disturbance index and the longest respiratory time were measured and Epworth scoring was investigated before and after therapy (Judging for the degree of drowsiness according to the appearing frequency of drowsiness : 0 score for never drowsiness; 1 score for occasional drowsiness; 2 scores for drowsiness sometimes; 3 scores for drowsiness often ). Pittsburgh sleep quality index(PSQI) (including sleep quality, falling sleep time, sleep time, sleep efficiency, sleep disorder, sleep drug and everyday function. Every function was scored according to 0,1,2,3. Adding each score formed the total score. The higher the total score was, the worse the sleep quality). 3-year follow-up was performed during the therapy. RESULTS: According to intention-to-treat analysis, 66 patients entered the result analysis after 3-year follow-up.① Epworth scoring and PSQI: that after therapy was significantly lower than that before therapy [(7.54±2.21),(2.85±1.56)scores,(13.67±4.72),(8.61±3.75)scores,P < 0.01]. ② Detection index of polysomnogram: Ventilation index, apnea index, respiratory disturbance index and the longest respiratory time after therapy was improved compared with that before therapy(P < 0.05).③The lowest oxygen saturation; that during the therapy and after therapy was significantly higher than that before therapy(P < 0.05), especially that during the therapy(P < 0.05); that after therapy was significantly lower than that during the therapy(P < 0.05).④ Blood pressure: that after therapy was significantly lower than that before therapy(P < 0.05). CONCLUSION: Longterm nasal continuous positive airway pressure therapy can improve sleep quality in patients with moderate and severe OSAHS , eliminate apnea and hypopnea when patients are sleeping, correct hypoxemia at night , treat hypertension caused by OSAHS.