阻塞性睡眠呼吸暂停低通气综合征患者日间嗜睡与清醒安静状态下动脉血氧饱和度的相关性研究

Relationship between excessive daytime sleepiness and oxygen saturation in obstructive sleep apnea-hypopnea syndrome

目的 探讨清醒安静状态下动脉血氧饱和度（SaO2）在阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者合并日间嗜睡发病机制的作用.方法 回顾性收集2010年1至4月在华西医院睡眠医学中心就诊的OSAS患者410例,呼吸暂停低通气指数（AHI）≥5次/h,每例都详细地询问病史和自评Epworth嗜睡量表（ESS）,并将OSAS患者分为日间过度嗜睡组（EDS）和非日间过度嗜睡组（No-EDS）;比较两组之间的人群结构特点及其睡眠参数.结果 176例EDS（ESS评分：15±3）与234例No-EDS（ESS评分：6±3）纳入研究,与No-EDS相比较,EDS组具有较大的体质量指数（BMI）（28±4比26±4,P＜0.001）、清醒安静状态下动脉血氧饱和度降低（93.4±4.3比95.5±1.9,P＜0.001）、REM睡眠潜伏期缩短（99±65比125±80,P=0.011）、AHI明显增加（56±21比45±22,P=0.006）;此外,两者间最低动脉血氧饱和度、氧减饱和指数和觉醒指数的差异均有统计学意义.EDS组清醒状态下平均SaO2（93.4±4.3比95.7±1.9）和重度OSAS患者清醒安静状态下SaO2（92.8±4.4比94.9±1.9）明显低于No-EDS组（P＜0.001）.结论 长期处于缺氧状态是重度OSAS患者合并嗜睡重要发生机制,纠正低氧血症是改善患者生活质量和嗜睡症状的重要手段.结合测定清醒安静状态下SaO2以及ESS评分,可以初步筛查和预测患者病情程度.

Objective To investigate polysomnographic determinants of excessive daytime sleepiness （EDS） and potential relationship in Chinese patients with obstructive sleep apnea-hypopnea syndrome （OSAS）. Methods A total of 410 patients with obstructive sleep apnea-hypopnea syndrome were analyzed retrospectively who were obtained in Sleep medicine center of West China hospital from January to April in 2010. All of the patients with an apnea-hypopnea index （AHI） greater than 5 h-1 were evaluated using the Epworth Sleepiness Scale （ESS） and sleep disorders questionnaire. The patients who ESS score was more than 10 were defined as EDS; otherwise, the other was considered to without EDS. Results A total of 176 patients with EDS（ ESS： 15 ± 3 ） and 234 without EDS （ ESS： 6 ± 3 ） were studied. Patients with EDS were slightly higher BMI （28 ±4 vs 26 ±4） and shorter REM sleep latency （99 ±65 vs 125 ±81 ） than patients without EDS. Furthermore, there were significant difference in awake SaO2, AHI, minimum SaO2,oxygen desaturation index and arousal index between EDS group were No-EDS group （ P 〈 0. 001 ）. There was a significant difference in waking SaO2 of severe OSAS between both groups. Conclusion Long-term chronic hypoxia already exists in severe OSAS patients with prominent sleepiness. Waking SaO2 may play a role as a predictor in evaluation and diagnosis in patients with OSAS.