中老年女性阻塞性睡眠呼吸暂停低通气综合征的社区调查

Epidemic survey of the middle and aged women related obstructive sleep apnea hypopnea syndrome in Beijing

目的探知中老年女性睡眠打鼾流行特征和阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的患病率、症状及相关因素.方法以问卷方式对北京市西城区丰盛街道办事处所辖区内40岁以上女性1336人进行横断面调查,其中1220人可以给出量表评分,根据评分分层抽样,对样本进行多道睡眠监测,以呼吸暂停低通气指数(apnea hypopnea index,AHI)≥5次/h且伴有白天嗜睡为诊断OSAHS标准,将样本分为病例组和健康对照组,推算调查人群患病率,比较病例组和健康对照组的症状,分析可能的相关因素对AHI的影响. 结果明确承认有不同程度打鼾者占34.3%,且随着年龄、体重指数升高,每周发生5～7次打鼾者的比率也趋于增高;生育期女性占3.8%,绝经期女性13.7%.调查对象总体OSAHS患病率为11.1%;单纯AHI≥5次/h、10次/h、15次/h者分别占41.1%、24.0%、17.0%.打鼾(5～7)天/周者的AHI是没有打鼾者的5倍,打鼾声隔壁也能听到者是非打鼾者的7.5倍;但病例组中有93.8%(15/16)存在不同程度的打鼾,健康对照组中也有79.1%(34/43),差异无统计学意义(P=0.182);病例组发生睡眠呼吸困难窒息、晨起口干的比率高于对照组,差异有统计学意义(P值分别为0.002、0.034).多元线性回归分析,AHI变量的24.4%可由体重指数(14.9%)和血清卵泡刺激素水平(9.5%)解释. 结论中老年女性人群中打鼾的发生率很高,OSAHS患病率为11.1%,主要表现为睡眠呼吸困难窒息、晨起口干;打鼾与病情严重程度密切相关,但不能作为区分患者的依据;肥胖程度和性激素水平与该综合征的发病可能有关.

Objective To find out the prevalence and risk factors related obstructive sleep apnea hypopnea syndrome（OSAHS） in Chinese women aged 40 years and older. Methods Participants living in communities must be of age ≥ 40 years and were given questionnaires, which developed a scale of 11 questions. Subjects were divided into three groups by scale scores. Those with higher scores were oversampled（ 2. 4% , 14.8%, 42. 1% respectively） and subjects of this community-based sample were recorded in the sleep laboratory to ascertain patients （apnea hypopnea index, AHI ≥ 5/h and daytime sleepiness）. Contrasting patients with the others as a control group, explored differences in symptoms.Stepwise multiple linear regression was used to determine the principal covariates affecting AHI. Results 34.3% of 1336 eligible women admitted various degree of snoring and 91.0% of those completed questionnaires. Crombach＇s ct coefficient of scale reached 0. 7025. Factor analysis reduced 11 questions of scale to four common factors as we have designed ： snoring, apneas,other symptoms, risk factors. Fifty-nine subjects experienced polysomnography evaluation. The ratios of patients to controls were 2： 25,4： 18,10：16 from lower scores group to higher. We estimated the prevalence of AHI 5,10, 15/h and OSAHS in this population were 41. 1% , 24. 0% , 17. 0% and 11.1% , respectively. As far as the frequency of sleep choking, xerostomia or pharyngoxerosis in the morning, these were significant differences between the OSAHS and non-OSAHS groups. Stepwise multiple linear regression analysis identified serum level folliclestimulating hormone and BMI as predictors of AHI. Conclusions This scale had good validity and reliability. Snoring and OSAHS are very common in Chinese women 40 years of age and older. Women with OSAHS did report sleep choking, xerostomia or pharyngoxerosis in the morning. BMI and sex steroids may all play a role in OSAHS.