阻塞性睡眠呼吸暂停低通气综合征与胃食管反流关系的研究

Research on the relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux

目的研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与胃食管反流（gastroesophageal reflux，GER）的关系。方法76例OSAHS患者行多道睡眠监测及夜间远端食管pH监测，评估OSAHS患者GER的发生率。对其中32例合并GER并适宜手术的OSAHS患者行悬雍垂腭咽成形术等手术治疗，术后6个月复查多道睡眠监测及远端食管pH值，对比术前、术后呼吸暂停低通气指数（AHI）、微觉醒指数（micro—arousal index，MAI）、最低动脉血氧饱和度（lowest SaO2，LSaO2）、远端食管酸化指数（pHindex，pHI）及食管酸暴露时间（acid contact time，ACT）百分比，并进行相关性分析。结果76例OSAHS患者AHI为（38．6±29．5）次／h（x^-±s，下同），伴发GER48例（占63．2％）。32例合并GER的OSAHS患者术前及术后6个月AHI分别为（51．2±23．1）和（17．3±10．3）次／h；MAI为（38．3±21．4）和（14．5±10．0）次／h；LSaO2为（0．698±0．107）和（0．858±0．076）；pHI为（12．5±6．6）和（6．3±4．2）次／h；ACT百分比为（10．3±5．2）％和（4．5±2．9）％，配对t检验差异均有统计学意义（t值分别为10．95、7．82、15．97、6．12、7．62，P值均〈0．001）。术后较术前AHI、MAI减少值与pHI的减少存在相关性（r值分别为0．775和0．764，P值均〈0．001）；AHI、MAI改善程度与ACT百分比减少存在相关性（r值分别为0．607和0．730，P值均〈0．001）。结论OSAHS患者较易发生夜间GER，对OSAHS的治疗在显著降低AHI、MAI的同时也明显改善了GER，提示夜间胃食管反流的发生与呼吸及睡眠紊乱有关。

Objective To study the relationship between obstructive sleep apnea and nocturnal gastroesophageal reflux （GER）. Methods Seventy-six patients with obstructive sleep apnea hypopnea syndrome （OSAHS） underwent polysomnography （PSG） and nocturnal distal esophageal pH monitoring, to assess the prevalence of GER in OSAHS patients. Among these patients, thirty-two OSAHS patients with GER disease had been operated on. Surgical treatment included uvulopalatopharyngoplasty （UPPP） , inferior turbinate reduction, nasal septoplasty et al. After 6 months of surgical treatment, the PSG and pH probe testing were rechecked. The pre and post operative apnea-hypopnea index （AHI）, micro-arousal index （MAI）, lowest artery oxygensaturation （LSaO2 ）, acidified index of distal esophagus （pHI） and percentage of acid contact time of esophagus were compared. The correlation analysis was also employed. Results The AHI of 76 OSAHS patients was （38. 6 ± 29. 5 ）/h （ x^- ± s ）, GEIR was present in 48 patients （63.2 % ）. The pre and post operative AHI, MAI, LSaO2 , pHI and percentage of ACT in 32 OSAHS patients associated with GER were （51.2 ± 23.1）/h and （17.3 ± 10.3）/h, （38.3 ± 21.4）/h and （14.5 ± 10.0）/h, 0.698±0.107 and0.858±0.076, （12.5 ±6.6）/h and （6.3±4.2）/h, （10.3±5.2）% and （4.5± 2. 9）%. The differences were statistically significant by matching t test （t were 10. 95, 7.82, 15.97, 6. 12, 7.62 respectively, P 〈 0. 001 ）. There were positive relationships between the reductions of AHI, MAI and the reductions of pHI （ r were 0. 775, 0. 764, P 〈 0. 001 ）. The improved levels of AHI and MAI were correlated with the reduction of the percentage of ACT （ r were 0. 607, 0. 730, P 〈 0. 001 ） .Conclusions GER is prevalent in OSAHS patients. Surgical treatment of OSAHS has significant reduction in AHI, MAI as well as marked improvement in the GER, which suggests that nocturnal gastroesophageal reflux is correlated with the disorder of sleep respiration and the sleep disturbances.