鼻咽通气管单夜治疗阻塞性睡眠呼吸暂停低通气综合征初步观察

One night treatment of obstructive sleep apnea and hypopnea syndrome with nasopharyngeal airway

目的 探讨用鼻咽通气管实验治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效及可行性.方法 符合OSAHS诊断标准的32例患者,采用Somte多道睡眠仪行第一夜即治疗前多道睡眠图（PSG）检查,第二夜整夜佩戴硅胶的鼻咽通气管实验治疗,同时行PSG监测.比较两夜的PSG监测指标,数据符合正态分布以x-±s表示,差异比较采用配对t检验.结果 佩戴鼻咽通气管单夜的耐受率为90.6%（29/32）.29例采用鼻咽通气管实验治疗时的呼吸暂停低通气指数（AHI）由（44.7±16.0）次/h降至（14.6 4±10.0）次/h 最长呼吸暂停时间由（44.3 4±11.5）s降至（30.1±13.2）s 最低动脉血氧饱和度由（0.722±0.080）提高到（0.861±0.070） 动脉血氧饱和度低于0.90时间在睡眠总时间中的构成比由（19.2±18.O）%降至（1.5±4.0）%,7项指标均较治疗前有明显改善（配对t检验,P值均〈0.001）.29例治疗当夜和次日,OSAHS主观症状明显改善,以AHI〈20次/h且降低幅度≥50%作为成功的标准,鼻咽通气管单夜治疗成功率为65.5%（19/29）.6例无效的患者,可能与舌后区阻塞所占比例较大有关.结论 单夜初步实验显示,鼻咽通气管对改善OSAHS腭后区阻塞有较好效果,为探索OSAHS新治疗技术提供参考.此外,鼻咽通气管实验治疗效果在判断阻塞平面方面也可能有应用前景,有待深入研究.

Objective To investigate the therapeutical effect and feasibility of treating obstructive sleep apnea hypopnea syndrome （OSAHS） with nasopharyngeal airway. Methods Thirty-two OSAHS patients were treated with silicone nasopharyngeal airway for one night. Each patient had Somte polysomnography（PSG） for the first night and repeated PSG with the nasopharyngeal airway treatment for the second night. PSG parameters were compared between the two nights. With normal distribution data in （x-±s）, Paired-Samples t test was used. Results Overall patient tolerance of the nasopharyngeal airway for one night was 90. 6% （29/32）. With the nasopharyngeal airway treatment, the AHI of the 29 patients decreased from（44.7 ±16.0）/h to （14. 6 ± 10. 0）/h, the longest time of apnea shortened from（44. 3 ± 11. 5） s to （30. 1 ±13.2）s,the lowest arterial oxygen saturation increased from （0.722 ±0.080 ） to（0.861 ±0.070） and the percentage of sleep time with arterial oxygen saturation 〈0.90 decreased from （19.2 ± 18.0 ） % to （1.5±4.0）%. Data showed obvious therapeutical effect （Paired-Samples t test, P 〈 0. 001 ）. The subject symptoms of the 29 patients improved obviously that night with treatment and the following day after treatment. The therapeutical successful rate for one night was 65. 5% （19/29, a reduction of AHI by 50% and AHI 〈20/h）. The noneffective reason of the six patients was probably that they had higher proportion of tonguebase obstruction. Conclusions The single-night preliminary experiment shows that the treatment using nasopharyngeal airway has obvious therapeutical effect for OSAHS patients with retropalatal obstruction and provides clinical evidence for developing a new treatment approach in the future. In addition, based on the result of nasopharyngeal airway treatment,the obstruction level may be evaluated.