长期自动调节压力持续正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的临床观察

A long term clinical observation in patients with obstructive sleep apnea/hypopnea syndrome treated by autocontinuous positive airway pressure

目的观察经过2年自动调节压力持续正压通气（AUTO-CPAP）治疗中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的患者体质量指数（BMI）的变化，停机后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSPO2）、微觉醒指数（MAI）、Ⅰ～Ⅱ期及Ⅲ～Ⅳ期睡眠时间占总睡眠时间百分比（Ⅰ～Ⅱ％，Ⅲ～Ⅳ％）的变化，探讨长期AUTO-CPAP呼吸机治疗对患者BMI的影响以及治疗后停机对患者的影响。方法选取42例中、重度OSAHS患者，经AUTO—CPAP治疗2年、治疗时间≥5h／d，治疗结束后对患者停机，并对患者行多导睡眠呼吸监测，观察治疗前后患者BMI、AHI、LSPO2、MAI、Ⅰ～Ⅱ％、Ⅲ～Ⅳ％的变化。结果长期AUTO—CPAP治疗前后患者BMI无明显变化（P〉0．05），当治疗停止时，AHI从（43．6±12，6）次／h减少到（36．7±11．2）次／h，减少了（6．8±3．2）次／h（P〈0．01），LSP02从（69．3±10．2）％上升到（76．4±8．1）％，升高了（7．1±2．6）％（P〈0．01），MAI从（38．1±12．2）次／h上升到（44．2±13．1）次／h，上升了（2．1±3．2）次／h（P〈0．01）。Ⅰ～Ⅱ％，Ⅲ～Ⅳ％无明显变化（P〉0．05）。结论长期AUTO—CPAP治疗OSAHS对患者BMI无明显影响；有利于降低患者原有AHI、提高LSPO2；停机后对患者的影响主要表现在MAI的增加，而与Ⅰ～Ⅱ％、Ⅲ～Ⅳ％无关。

Objective To observe the changement of body mass index （BMI）, apnea hypopnea index （AHI）, lowest pulse oxygen saturation （LSPO2）,micro-arousal index （MAD, percentage of sleep Ⅰ～Ⅱ stage time and Ⅲ～Ⅳ stage time in the total time （ Ⅰ～Ⅱ %, Ⅲ～Ⅳ） in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） who had been treated with auto-continuous positive airway pressure （AUTO-CPAP） for two years. Methods The 42 patients who were diagnosized OSAHS with polysomnography （PSG） had been treated with AUTO-CPAP for two years, and the treatment time was not less than 5 hours pre day. The second PSG was taken in this patients after a two-years treatment. To observe the changement of the BMI, AHI, LSPO2, MAI, Ⅰ～Ⅱ %, Ⅲ～Ⅳ from pre-treatment to post-treatment. Results The BMI showed no difference between pre-treatment and post treatment （ P 〈0.05）. When the treatment being quitted, AHIreduced （6.8±3.2） times/h from （43.6±12.6） times/h to （36.7±11.2） times/h （P 〈0.05）. And LSPO2 raised （7.14±2.6）% from （69.3± 10.2）% to （76.4±8.1）% （P 〈0.05）. The MAI raised （2.1±3.2） times/h from （38.1±12.2） times/h to （44.2±13.1） times/h （ P 〈0.05）. And Ⅰ～Ⅱ %, Ⅲ～Ⅳ% shows no difference between pre-treatment and post-treatment （ P 〉0.05）. Conclusions A long term treatment with AUTO-CPAP shows likely no influence to the BMI of the patients with OSHAS. A long term treatment with AUTO-CPAP is maybe benefit to the AHI and LSPO2. When the treatment being quitted, the influence to the patient not lies in Ⅰ～Ⅱ %, Ⅲ～Ⅳ% but in theMAI.