睡眠呼吸紊乱患者的警觉性测定

Assessment of vigilance for patients with sleep disordered breathing

目的检测几种临床常见的睡眠呼吸紊乱患者的警觉性是否受损。方法前瞻性地对因疑诊而接受全晚睡眠监测的患者，在监测前（傍晚）和监测后（早上），利用电脑模拟开车试验，以碰撞障碍物的百分率，衡量其警觉性。以等级方差分析检验各组间早晚平均碰撞率（％Ｈｍ）的差异，并将％Ｈｍ与睡眠监测有关参数作等级相关分析。结果正常人和按诊断分组后患者的％Ｈｍ［以中位数（范围）表示］为：正常人（１１名）０．６（０～２．５）；睡眠鼾症（７例）１．１（０．２～２．０）；阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ，２２例）２．２（０．２～７．７）；中枢性睡眠呼吸暂停综合征（ＣＳＡＳ，６例）２．７（０．９～５．４）。除睡眠鼾症组外，各组患者％Ｈｍ均高于正常人（Ｐ＜０．０５）。正常、睡眠鼾症及ＯＳＡＳ三组合并分析表明：％Ｈｍ与睡眠累计低血氧饱和度时间％有相关性（ｒ＝０．４１，Ｐ＜０．０５）而与呼吸停顿／低呼吸指数和觉醒指数无明显相关（ｒ分别为０．２２和０．１０，Ｐ＞０．０５）。结论ＯＳＡＳ和ＣＳＡＳ患者的警觉性下降，睡眠鼾症患者的警觉性大致正常。

Objective Assessment of vigilance for patients with sleep disordered breathing. Methods Vigilance of the patients referred to sleep study for suspected sleep disorders was evaluated prospectively by a computerized driving simulator SteerClear before (evening) and after (next morning) nocturnal sleep study. The vigilance was quantified by means of the averaged percentages of obstacle hitting made during the evening and the morning driving test, abbreviated as %Hm. Controls included 11 normal volunteers. Kruskal Wallis ANOVA by Rank was used to compare the %Hm in patients with that in normal controls; Spearman Rank Correlation was used to analyze the relationship between %Hm and parameters obtained from sleep study. Results The %Hm in normal subjects and in patients were (expressed as median and range): normal subjects 0.6 (0～2.5), n =11; sleep snoring 1.1 (0.2～2.0), n =7;obstructive sleep apnea syndrome (OSAS) 2.2(0.2～7.7), n =22;central sleep apnea syndrome (CSAS) 2.7(0.9～5.4), n =6. The %Hm of the patients with OSAS and CSAS but not the patients with sleep snoring ( P >0.05) was significantly higher than that of normal subjects ( P <0.05). Among the normal subjects, the patients with OSAS or with sleep snoring, there existed a significant correlation between the %Hm and the percentage of cumulated time spent at the oxygen saturation below 90% ( r =0.41, n =40, P <0.05), whereas the %Hm was not correlated to apnea/hypopnea index ( r =0.22, n =40, P >0.05) nor to arousal index ( r =0.10, n =17, P >0.05). Conclusions The vigilance of the patients with OSAS or CSAS but not those only with sleep snoring is impaired, the impairment may relevant to the oxygen desaturation during their sleep.