成人低氧血症指标在阻塞性睡眠呼吸暂停低通气综合征诊断中的应用

Applied values of hypopneic indices in the treatment for obstructive sleep apnea-hypopnea syndrome in adults

目的探讨夜间缺氧程度与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopneasyndrome,OSAHS)严重程度的相关关系及各血氧指标在反映缺氧程度上的应用价值。方法选取514例初步诊断为OSAHS的患者进行多导睡眠图(Polysommography,PSG)监测,记录患者有效睡眠时间占记录时间百分比(睡眠效率)、呼吸暂停次数、低通气次数、呼吸紊乱指数(apnea-hypopnea index,AHI)、最低血氧饱和度(lowest ar-terial oxygen saturation,LSaO2)及血氧饱和度<90%的累积时间占总监测时间的比例(the percentage of the totalrecorded time spent below 90%oxygen saturation,TS90%)、氧减指数(oxygen desaturation index,ODI)、最大氧减及最长氧减时间,根据PSG检测结果分为4组;并分析以上指标与OSAHS病情严重程度的关系。结果LSaO2、TS90%、ODI、最大氧减及最长氧减时间在各组间的差异有统计学意义(P<0.001);同时,以上因素与OSAHS的严重程度有明显的相关关系,其中,TS90%与AHI的相关系数最大r=0.803(P=0.000)。不同程度的TS90%参考值范围如下:正常TS90%≤2%,轻度2%<TS90%≤12%,中度12%<TS90%≤28%,重度TS90%>28%。结论夜间缺氧程度与OSAHS病情严重程度成正相关,其中TS90%是反映夜间缺氧程度的最稳定指标。

Objective To explore the relationship between the severity of obstructive sleep apnea hypopnea syndrome （OSAHS） and the degree of hypoxia in adults; and the applied value of every blood oxygen index in evaluating the degree of hypoxia. Methods 514 patients with snore suspected of OSAHS were monitored by polysomnography （PSG） and divided into 4 groups according to their PSG results. The percentage of valid sleep accounting for the total sleeping time （sleep efficiency）, time of apnea or hypopnea, apnea-hypopnea index, average arterial oxygen saturation, lowest arterial oxygen saturation （LSaO2）, the percentage of the total recorded time spent below 90% oxygen saturation （TS90%）, the oxygen reduction index （ODD, the largest SaO2 reduction, and the duration of the largest SaO2 reduction were recorded and analyzed. Results The differences of LSaO2, TS90%, ODI, the largest SaO2 reduction, and the duration of the largest SaO2 reduction among above groups were statistically significant. And all these indices were ignificantly correlated with the severity of OSAHS. Among them, the correlation coefficient between TS90% and AHI was the largest （ r =0. 803, P =0. 000）. The reference value scopes of TS90% in the four groups were as follows： TS90%≤2% （normal group）, 2〈TS90%≤12% （mild group）, 12%（TS90%≤28% （moderate group）, and TS90%≤28%（severe group） . Conclusion The degree of nighttime hypoxia is positively correlated with the severity of OSAHS. TS90% is the most stable indicator to evaluate degree of hypoxia.