老年心血管疾病患者阻塞性睡眠呼吸暂停综合征的评价

An evaluation of obstructive sleep apnea syndrome in elderly patients with cardiovascular disease

目的评价老年心血管疾病患者阻塞性睡眠呼吸暂停综合征（OSAS）的患病情况和特点，为临床决策提供参考。方法采用便携式睡眠监测仪对入住在老年心内科的患者，进行睡眠呼吸监测，了解其阻塞性睡眠呼吸暂停（OSA）的患病情况。结果共监测了317例老年心血管疾病患者的夜问睡眠呼吸紊乱情况，得出符合OSA[睡眠呼吸紊乱指数（AHD≥5]的有281例，占88．6％；符合阻塞性睡眠呼吸暂停综合征（OSAS）[AHI≥5，Epworth量表（ESS）≥9分]的有47例，占14．8％。多元回归分析结果提示，以OSA严重程度作为因变量，对它影响有显著性意义的是最低血氧饱和度和血氧饱和度下降指数（简称氧减指数），而年龄、习惯性打鼾、嗜睡评分、体质指数（BMI）、血氧饱和度平均值和低于90％的时间对其影响无显著性意义。结论老年心血管疾病患者中OSAS具有高的患病率，而且无白天嗜睡症状的OSA的老年人患病率更高。对睡眠呼吸暂停严重程度的独立预测因子是最低血氧饱和度氧减指数，而老年人的年龄、BMI、是否经常打鼾、是否白天嗜睡与0SA的严重程度关系不密切。

Objective To evaluate the prevalence of obstructive sleep apnea syndrome （OSAS） and its characteristics in elderly patients with cardiovascular diseases, and provide reference for the clinical decisions. Methods All patients who were hospitalized in department of cardiovascular medicine from January to June in 2007 were invited to participate in the current study. A total of 317 hospitalized elderly patients were recruited into this study. All participants were assessed by portable bedside nocturnal polysomnograph and Epworth sleepiness scale （ESS）. Results Among 317 patients, 281 cases （88.6 %） met the criterion of Obstructive sleep apnea （OSA）[apnea and hypopnea index （AHD≥5] and 47 cases （14.8%） met the criteria of obstructive sleep apnea syndrome （OSAS） （AHI ≥5 and ESS≥9）. When the severity of OSA （as indicated by AHI） was considered as a dependent variable, multiple regression analysis indicated that it was significantly associated with minimal SaO2 and the oxygen desaturation index, while age, habitual snoring, ESS, BMI, mean SaO2 and the duration of SaO2≤ 90% did not show significant effects on the severity of OSA. Conclusions High prevalence of obstructive sleep apnea syndrome （with daytime sleepiness） is found in elderly hospitalized patients and the rate of obstructive sleep apnea is much higher in patients without daytime sleepiness symptoms. Minimal SaO2 and the oxygen desaturation index are the important predicting factors for the severity of OSA, while age, BMI, habitual snoring, sleepiness are not correlated with the severity of OSA after adjusting minimal SaO2 and oxygen desaturation index.