阻塞性睡眠呼吸暂停低通气综合征患者睡眠片段的评估-脉搏传导时间微觉醒

Pulse transit time as a measure of arousal in patients with obstructive sleep apnea hypopnea syndrome

目的脉搏传导时间(PTT)是一项反映周围血管阻力和胸腔内压变化的无创指标,因此和微觉醒相关的血压改变可通过PTT检测。本文评估PTT微觉醒能否作为阻塞性睡眠呼吸暂停低通气综合征患者睡眠片断的指标。方法选择疑诊有睡眠呼吸障碍者39例,使用Rembrandt和HypnoPTT睡眠监测系统进行同步夜间睡眠呼吸监测,监测前进行ESS(epworth sleepiness scale)嗜睡评分。对三项常规判断睡眠片断的客观指标:脑电图(EEG)微觉醒指数、呼吸暂停低通气量指数(AHI)、氧减指数(ODI)和反映嗜睡的主观指标ESS评分,同PTT微觉醒指数进行比较。结果PTT微觉醒指数和EEG微觉醒指数之间呈正相关(r=0.725,P<0.01);PTT微觉醒指数、EEG微觉醒指数分别与呼吸事件(AHI、ODI)之间呈正相关(r=0.791;r=0.670;r=0.755;r=0.765,P分别小于<0.01)。而PTT微觉醒指数和EEG微觉醒指数与ESS评分之间相关性较差(r=0.449;r=0.196,P分别>0.01)。结论PTT微觉醒和反映阻塞性睡眠呼吸暂停低通气患者睡眠片断的其他指标密切相关,可作为判断睡眠片断的一项简单而准确的客观指标。

Objective Pulse transit time （PTT） is a non-invasive index which reflects changes in peripheral vascular resistance and intra-thoracic pressure. Using beat to beat blood pressure monitoring it has been possible to score these cardiovascular changes to estimate sleep fragmentation. This study was designed to evaluate the PTT arousals as an index of sleep fragmentation in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods Three conventional indices of sleep fragmentation（EEG arousals, AHI,ODI） ,PTT arousals and epworth sleepiness scale（ESS） have been compared. Results The correlation between PTT arousals and EEG arousals were good（ r =0. 725） ; The correlation between PTT arousals and respiratory events were good（ r =0. 791 with AHI; r =0. 670 with ODI） ;But,the relationship between the indices of sleep fragmentation and ESS were poor （ r = 0. 449; r = 0. 196）. Conclusions The PTT arousal correlates well with other standard measures of severity in patients with OSAHS and is potentially a non-invasive marker with which to measure the sleep fragmentation in patients with OSAHS.