飞行人员阻塞性睡眠呼吸暂停低通气综合征危险因素研究

Study on the risk factors of sleep apnea-hypopnea syndrome in aircrew

目的研究分析飞行人员阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的危险因素,为制订OSAHS防治策略提供依据。方法对410例军事飞行人员进行问卷调查。对打鼾者和(或)Epworth嗜睡量表(ESS)评分≥9分者,进行夜间脉搏血氧饱和度初筛检测。其中,氧减饱和指数≥10次/h者,进行整夜多导睡眠图(PSG)监测。临床高度怀疑OSAHS者,直接进行PSG监测。根据检查结果分为3组:OSAHS组,单纯鼾症组,正常对照组。对年龄、颈围、腰围、体质指数、身高、体重、血脂、血糖、尿酸、打鼾家族史、吸烟情况、飞行机种、飞行时间和ESS评分等14个因素进行方差分析和Logistic回归分析。结果3组间飞行时间、年龄、吸烟情况、ESS评分、体质指数、体重、颈围、腰围、血糖和血脂均有显著差异(F=3.89～71.64,P<0.05)。经单因素Logistic回归分析,筛选出打鼾家族史、年龄、体质指数、颈围和三酰甘油进行多因素Logistic回归分析,结果显示此5因素的分组每增加1个等级,患病等级增加1个或1个以上等级的可能性分别增加到原来的4.115倍、2.905倍、2.031倍、2.200倍和1.849倍。结论有打鼾家族史、年龄大、体质指数高、颈围增粗及血三酰甘油高为飞行人员OSAHS的危险因素,应在招飞及日常航卫保障工作中针对危险因素采取有效的防治措施。

Objective To investigate the risk factors of obstructive sleep apnea-hypopnea syndrome （OSAHS） in aircrew, so as to provide reference for medical prevention and treatment of OSAHS. Methods A questionnaire of sleep was performed in 410 aircrew members. According to the answers of questionnaire, those with snoring during sleep and （or） Epworth sleepiness scale （ESS） score≥9 were screened with pulse oxygen saturation test during sleep in the night. Those with oxygen saturation decrease index ≥10 times/h and those highly suspected having OSAHS were tested by polysomnography. Based on the above test results, 410 aircrew members were separated into three groups： the OSAHS group, the snore group and the control group. Data including age, neck circumference, waist circumference, body mass index （BMI）, height, weight, blood lipid, blood glucose, uric acid, snoring family history, smoking, aircraft type, flying time and ESS score were examined. All these data were processed with variance analysis and Logistic step wise-regression. Results There were significant differences among the three groups on 10 factors including flying time, age, smoking,ESS score,BMI, weight, neck circumference, waist circumference, blood glucose and blood lipid（F=3.89-71.64,P〈0. 05）. If any of the risk factors, such as family history of snore, age, BMI, neck circumference and triglyceride increased one grade, the possibility of one grade increase on suffering OSAHS would be 4. 115 times, 2. 905 times, 2. 031 times, 2. 200 times and 1. 849 times, respectively. Conclusion History of snore, age, neck circumference, BMI and triglyceride are five risk factors of OSAHS for aircrew. Effective strategy on the prevention and treatment of OSAHS should be performed in selecting cadet candidates and daily aeromedical protection.