支气管哮喘临床控制与睡眠呼吸障碍的关系

Relationship between clinical control of bronchial asthma and sleep-disorder breathing

目的分析合并及未合并睡眠呼吸暂停低通气综合征哮喘患者的临床特点、哮喘临床控制率及相关因素,为哮喘的防治提供治疗策略。方法对88例哮喘患者经睡眠问卷调查及哮喘控制测试(ACT)评分调查,行夜间血氧饱和度监测和肺功能测定,夜间血氧监测指标包括氧减饱和指数(ODI4)、最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、血氧饱和度低于90%的时间占睡眠总时间的百分比(SIT90%)。按照ACT评分和ODI4值分组,ACT评分≤19分为哮喘临床未控制组,ACT评分>19分为哮喘临床控制组,ODI4值≥10次/h为哮喘合并睡眠呼吸暂停低通气综合征(SAHS)组,ODI4值<10次/h为单纯哮喘组。比较各组肺功能的差异。结果哮喘控制组与哮喘未控制组体质量指数(BMI)、FVC、ODI4、LSaO2、MSaO2、SIT90%差异有统计学意义(P<0.05)。单纯哮喘组与哮喘合并SAHS组哮喘临床控制率(23.8%、6.3%)及汉族与维族哮喘组间哮喘临床控制率(28.6%、9.5%)差异有统计学意义(P<0.05～0.01)。结论哮喘临床控制与否和肺功能、夜间低氧及是否合并SAHS有关,ACT哮喘控制测试评分结合肺功能及夜间血氧监测能够全面评估哮喘患者的病情。

Objective To compare the clinical features of bronchial asthma with and without sleep apnea hypopnea syndrome（SAHS）,to analyze the rate and related Factors on clinical asthma control between two groups and to provide strategies for treatment and prevention of asthma.Methods 88patients with stable asthma were underwent home pulse oximeter testing and Respiratory function testing.All Subjects were received Questionnaire Survey and asthma control test（ACT）,From Overnight Pulse Oximetry,nocturnal oxygen deaturation measurements include the percentage of time spent at SaO2below 90%（SIT90%）,the nocturnal mean arterial oxygen saturation（MSaO2%）,the minimal arterial oxygen saturation（LSaO2%）and the number oxygen desaturations≥4%index per hour（ODI4）.All subjects were grouped according to ACT scores and ODI4.On basis of ACT score 20as cutoff vulue,Clinical asthma control group was defined by score of ACT≥20whereas clinical athma non-control group was defined by score of ACT20.On basis of ODI4,Asthma with SAHS group was defined by deemed screening-positive as oxygen desaturation of the peripheral artery of 4%or greater if 10or more events were observed per hour（ODI4or=10）whereas Asthma alone group was defined by less 10events were observed per hour（ODI4 10）.Results The result showed that there are significant difference on ODI4,MSaO2,LSaO2,SIT90,BMI and FVC%,between clinical asthma control group（18cases）and clinical asthma non control group（20cases）（P〈0.05）;There are significant difference on the rate of clinical asthma control between asthma alone group（44cases）and asthma with SAHS group（32cases）（23.8% VS 6.3%,P〈0.05）.The clinical control rate in Asthma with SAHS group was significantly less than that in asthma alone group;There are significant difference on the rate of clinical asthma control between Han ethnic group and Uygur ethnic group（28.6% VS 9.5%,P〈0.05）.The rate of clinical asthma control in Uygur ethnic group was less than Han ethnic group.Conclusion Clinical asthma was correlated with nocturnal desaturation,SAHS and pulmonary Function.Combination of ACT with pulmonary Function and nocturnal desaturation can better quantify patient＇s condition of asthma.