女性阻塞性睡眠呼吸暂停低通气综合征的危险因素及治疗现状分析

Risk Factors of Obstructive Sleep Apnea Hypopnea Syndrome and Its Treatment in Female Patients

目的分析女性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的危险因素,并随访其治疗现状及健康相关生活质量。方法纳入以睡眠呼吸紊乱为主诉的女性病例193例,分为非OSAHS组和OSAHS组,比较两组年龄、体质量指数(BMI)、绝经及患高血压的比例之间的差异及上述参数与睡眠呼吸暂停低通气指数(AHI)、最低脉氧饱和度(LSpO2)之间的关系,并分析各组治疗的现状及疾病相关的生活质量的预测因子。结果 OSAHS组平均年龄、BMI、绝经及患高血压的比例均高于非OSAHS组(P<0.05)。AHI及LSpO2与年龄、BMI、是否绝经及患高血压之间存在相关关系。两组治疗采用最多的是减肥及体位治疗。OSAHS组采取减肥及持续气道正压通气(CPAP)治疗后Epworth嗜睡评分(ESS)较前降低(P<0.05),采取体位治疗病例前后ESS之间差异无统计学意义(P>0.05),未采取任何治疗措施的病例占了OSAHS组32.5%,随访ESS评分较前增高(P<0.05)。根据Berlin问卷,OSAHS组目前仍有超过50%的病例高度怀疑存在OSAHS。Calgary生活质量指数(SAQLI)及其各项维度两组之间无差异,多元回归分析纳入了匹兹堡睡眠质量指数(PSQI)、ESS、AHI、LSpO2作为SAQLI的预测因子,差异有统计学意义(P<0.05)的有PSQI、ESS、AHI。结论年龄、BMI、绝经及患高血压是女性OSAHS的危险因素,目前女性OSAHS患者的治疗不充分,且病情与行PSG监测时比有逐渐加重趋势,PSQI、ESS、AHI可以作为女性OSAHS健康相关生活质量的预测因子。

Objective To identify risk factors of obstructive sleep apnea hypopnea syndrome（OSAHS） in female patients,and assess its treatment and healthrelated quality of life（HRQoL） of the patients.Methods One hundred and ninety three female patients undergoing polysomnography whith sleep breath disorders were recruited and divided into non-OSAHS group and OSAHS group.Age,body mass index（BMI）,and prevalence of menopause and hypertension were compared between the two groups.The associations of those variables with apnea hypopnea index （AHI） and lowest pulse oxygen saturation（LSpO2） were analysed.The treatment of OSAHS and its impact on HRQoL assessed by the Calgary quality of life index（SAQLI） were evaluated.Results The OSAHS group had greater mean age,BMI,and prevalence of menopause and hypertension than the non-OSAHS group（P0.05）.Those variables were significantly correlated with AHI and LSpO2（P0.05）.Weight control and positional therapy were the most common treatment for sleep breath disorders.Weight loss and continuous positive airway pressure improved the Epworth sleep scale（ESS） of the patients with OSAHS significantly（P0.05）.But positional therapy made no difference（P0.05）.The ESS of the 32.5% of patients who did not undergo any treatment was worsened during the same period of time（P0.05）.No differences were found in the scores of the four domains of SAQLI between the two groups（P0.05）.The stepwise multiple regression analysis identified Pittsburgh sleep quality index（PSQI）,ESS and AHI as independent predictors for the total score of SAQLI（P0.05）.Conclusion Older age,greater BMI,menopause and hypertension are risk factors of OSAHS in female patients.OSAHS was not well managed in female patients.PSQI,ESS and AHI can be used as predictors for HRQoL.