原发性甲状腺功能减退合并睡眠呼吸暂停综合征的临床分析

Clinical study of sleep apnea syndrome in the patients with primary hypothyroidism

目的:探讨原发性甲状腺功能减退(以下简称甲减)合并睡眠呼吸暂停综合征(SAS)的临床特点,提高临床诊治水平。方法:对北京安贞医院呼吸科2002年5月至2009年12月诊治的甲减合并睡眠呼吸暂停综合征15例患者的临床资料进行回顾性分析。结果:甲减合并睡眠呼吸暂停综合征患者女性略多于男性(男性7例,女性8例),年龄29～70岁。15例患者中,4例有甲减病史,均为同位素治疗后甲减,病程3～30年;11例为新诊断甲减患者。临床表现为白天嗜睡(15/15)、打鼾(15/15),夜间憋醒(5/15),记忆力减退、注意力不集中、疲倦(15/15)、畏寒(12/15)、便秘(10/15)及黏液性浮肿(12/15)。多导睡眠监测结果:睡眠呼吸暂停指数(AHI)14.9～91.9次/h,平均(52.0±19.8)次/h,重度SAS12例,中度SAS2例,轻度SAS1例;其中阻塞性9例,中枢性1例,阻塞性并混合性5例。最低血氧饱和度(LSaO2)86%～47%,平均(70.1±11.7)%。嗜睡评分(ESS)11～18分,平均(14.3±1.7)分。7例患者首诊为冠心病。结论:甲减合并睡眠呼吸暂停综合征,以重度阻塞性睡眠呼吸暂停综合征居多,发病年龄广、病程长,二病有许多相似的临床表现,容易漏诊,应引起重视。

Objective：To investigate the clinical characteristics of primary hypothyroidism with sleep apnea syndrome（SAS） and therefore to improve the diagnosis and treatment.Methods：Cases（n = 15） with hypothyroidism complicated with sleep apnea syndrome in Department of Respiratory of the Beijing Anzhen Hospital of The Capital Medical University from May 2002 to December 2009 were retrospectively analyzed.Results：In 15 patients with primary hypothyroidism complicated with SAS in women were more than men（7 males and 8 female）,with an average age of onset at（57 ± 13）years,（ranging from 29 to70 years）.4 cases had history of primary hypothyroidism,11 cases of primary hypothyroidism were newly diagnosed.The main clinical symptoms included excessive daytime somnolence（15 /15）,loud snoring（15/15）,nighttime dyspnea awakenings（5/15）,memory loss、poor concentration and fatigue（15/15）,chills（12 /15）,constipation（10/15）,myxedema（12/15）.All patients were monitored for one overnight sleep study using polysomnography,the sleep apnea hypopnea index（AHI） was 14.9-91.9/h,average（52.0 ± 19.8） /h,the lowest SpO2（LSaO2） was 86%-47%,average（70.1 ± 11.7）%.Epworth scale score was 11-18 cent,average（14.3 ± 1.7） cent.According to monitoring results found that 12 patients with severe,2 patients with moderate and 1 patient with mild.Conclusions：Our experience suggests that there is high incidence of sleep apnea among hypothyroid patients.Age of onset was widespread.There are many clinically apparent similarities between patients with SAS and with hypothyroidism,they be missed easily.More attention should be paid to patients.