阻塞性睡眠呼吸暂停低通气综合征白天高碳酸血症相关因素的研究

A Correlative Study of OSAHS and Daytime Hypercapnia

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)件白天高碳酸血症的患病率,并与白天不伴高碳酸血症患者资料进行比较,经相关和回归分析探寻导致白天高二氧化碳的影响因素,以提高对本病的认识。方法对连续收集到的肺功能正常的110例OSAHS中29例伴白天高碳酸血症者(研究组)与白天无高碳酸血症者81例(对照组)进行比较,现察两组年龄、体重指数(BMI)、肺功能、白天血气、夜间动态血氧饱和度(SaO2)、多导睡眠图(PSG)的差别,井对与PaCO2有关的因素进行相关和回归分析。结果两组一秒率(FEV1／FVC)差异无显著性(P>0．05),研究组较对照组年轻,BMI、呼吸暂停低通气指数(AHI)较对照组高(P<0．05)。研究蛆白天PaO2显著低于对照组, PaCO2、[HCO3- ]显著高于对照组(P<0．001)。研究组夜间平均SaO2(MSaO2)、最低SoO2(LSaO2)显著低于对照组,氧饱和度≤90％的时间占总监测时间的百分比(SIT90)显著高于对照组(P< 0．05)。高碳酸血症组白天PaCO2与MSaO2、LSaO2呈负相关(r值分别为-0.625;-0．429),与SIT90、AHI呈正相关(r值分别为0．563;0．385)。经回归(逐步筛选法)分析,高碳酸血症组MSaO2可以解释引起白天PaCO2升高因素中的39．1％(R2=0.391,P=0．001)。结论OSAHS伴白天高碳酸血症的患病率为26．4%。伴白天高碳酸血症者多见于青年和中年患者并且较肥胖,夜间缺氧程度较白天无高碳酸血症者更为严重,提示病情较重。白天高碳酸血症与夜间缺氧有关,MSaO2是引起OSAHS白天高碳酸血症的重要因素之一,可将其作为OSAHS伴白天高碳酸血症的一个预测指标。

Objective A comparative study of the prevalence of patients in obstructive sleep apnea hypopnea syndrome （OSAHS） and to understand of this disease. Methods For constantly collected 110 OSAHS patients with normal lung functions, a comparison on the 29 patients with daytime hypercapnia （the treatment group ） and the 81 without daytime hypereapnia （the control group ）were conducted, to investigate their difference in age, body mass index （BMI）, pulmonary function, daytime bloods gas, nocturnal arterial oxygen saturation （SaO2） and polysomnography （PSG）. The statistical methods of correlation and regression analysis were used on PaCO2 related factors. Results There was no significant difference in the FEVi/FVC （P〉0. 05）. The subjects of the treatment group were younger than those of the control group. In the treatment group, BMI and AHI were higher （P〈 0. 05）, daytime PaO2 was lower （P〈0. 001）, daytime and [HCO3] were higher （P〈0. 001）, nocturnal mean of SaO2 （MSaO2） and the lowest SaO2 （LSaO2） were significantly lower, and SIT90 was significantly higher （ P〈0. 05）. In the treatment group, an inverse correlation between daytime PaCO2 and MSaO2, LSaO2 was observed （r=-0. 625; -0. 429）, a positive correlation between daytime PaCO2 and SIT90, AHI were found （r=0. 563; 0. 385）, and the mean SaO2 accounted for 39. 1% of the total variance in daytime PaCO2 levels （R2 =0. 391 P=0. 001） using stepwise multiple regression analysis. Conclusion The prevalence of the patients in OSAHS with daytime hypercapnia was 26. 4%.The young or middle-aged overweight patients were easier to suffer from OSAHS with daytime hypercapnia. The daytime hypercapnia was associated with nocturnal hypoxia. MsaO2 was one of the important factors that conduce to OSAHS with daytime hypercapnia.