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能量代谢的影响

Treatment effect of continuous positive airway pressure on energy expenditure in patients with obstructive sleep apnea hypopnea syndrome

目的研究中重度阻塞性睡眠呼吸暂停低通气综合征（0SAHS）患者经鼻面罩持续气道正压通气（CPAP）治疗前后能量代谢的变化特点。方法选取2004年3月至2006年5月在我院睡眠疾患诊治中心就诊的30例中重度OSAHS患者，分别于CPAP治疗前后测量入睡前及非快速眼动（NREM）Ⅰ～Ⅱ期睡眠时静息能量消耗（REE）。同时随机选取我院健康体检中心和我院健康职工其性别、年龄、体质量指数（BMI）均与之相当的30例作为对照组。结果OSAHS组入睡前REE高于对照组F9别为（1823±88）kcal／d、（1537±130）kcal／d]，差异有显著性意义（P〈0．01）。与入睡前相比，NREMⅠ～Ⅱ期睡眠时OSAHS组REE明显增高F9别为（1823±88）kcal／d、（3726±650）kcal／d]，而对照组[（1434±135）kcal／d]明显降低，差异均有显著性意义（P均〈0．01）。经鼻面罩CPAP治疗后，OSAHS患者入睡前REE降至（1573±130）kcal／d，与治疗前相比差异无显著性意义（P〉0．05）；睡眠时0SAHS组REE降至（2393±456）kcal／d，与治疗前相比差异有显著性意义（P〈0．01）。结论OSAHS患者存在能量代谢异常，经CPAP治疗后其NREMⅠ～Ⅱ期睡眠时REE明显下降。

Objective To examine the effect of continuous positive airway pressure（CPAP） treatment on energy expenditure（EE） in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods Resting energy expenditure （REE） was measured in 30 patients with OSAHS and 30 non-snoring control subjects during both wakefulness and non-rapid eye movement sleep （NREM）. The two groups were matched for age, sex and BMI. REE was remeasured in patients with OSAHS after 5-8 weeks CPAP treatment. Results During wakefulness, REE in OSAHS patients was significantly higher [（1823 ± 88） kcal/d]than that in the controls [（1537± 130） kcal/d, P 〈0.01]. During NREM sleep, REE in OSAHS patients increased significantly [ （ 1823 ± 88） kcal/d vs （3726 ± 650） kcal/d, P 〈 0.01]. However REE in controls decreased [（1537±130） kcal/d vs （1434± 135） kcal/d, P 〈0.01]. CPAP treatment induced REE significant reduction [（3726±650） kcal/d vs （2393±456） kcal/d, P 〈0.01],the REF during wakefulness also had a tendency to decrease [（ 1823 ±88） kcal/d vs （1573 ±130） kcal/d, P 〉0.05]. Conclusions OSAHS is associated with an increased sleep REE, which is partially normalized by 5-8 weeks CPAP treatment.