生活方式干预对阻塞性睡眠呼吸暂停低通气综合征患者的影响

Survey on the effects of life-style intervention on obstructive sleep apnea-hypopnea syndrome

目的探讨生活方式干预对阻塞性睡眠呼吸暂停低通气综合征的效果。方法将168例OSAHS患者分为干预组81例及对照组87例，干预组在悬雍垂腭咽成形术治疗的基础上，实施生活方式干预，即认知指导、合理膳食、控制体重、戒烟戒酒、加强锻炼等干预措施；对照组单纯采用悬雍垂腭咽成形术治疗，生活如常。在术后1，6，12，24个月进行多导睡眠监测、体重指数、症状评估，随访观察2年以上。结果干预前两组患者生活方式差异无统计学意义（P〉0．05），干预后干预组合理饮食、戒酒或限酒、戒烟或限烟、体重控制或减轻、坚持适量运动患者所占比率分别为93．8％，86．4％，69．1％，81．5％，87．7％，均高于对照组（11．5％，36．8％，21．8％，17．2％，9．2％），差异均有统计学意义（x。分别为113．80，43．33，37．97，69．33，103．70；P〈0．01）；干预后6，12，24个月干预组最低血氧饱和度、呼吸暂停低通气指数、鼾声指数、体重指数，与对照组比较差异有统计学意义（t分别为2．51，4．13，7．88；2．10，2．66，3．68；3．42，4．17，9．34；5．92，12．78，9．37；P〈0．01）；干预组各项指标干预前后比较差异有统计学意义（P〈0．01），而对照组干预前后比较差异无统计学意义（P〉0．05）。结论阻塞性睡眠呼吸暂停低通气综合征在悬雍垂腭咽成形术治疗的基础上，进行健康的生活方式干预，可明显改善临床症状、提高手术治疗远期疗效，降低心脑血管等并发症的发生，不仅提高了患者生活质量，同时也减轻患者经济负担，值得临床推广应用。

Objective To investigate the effects of life-style intervention on obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods A number of 168 cases with OSAHS were randomized into intervention group （n = 81 ） and control group （n = 87）. In the interventional group, the patients received uvulopalatopharyngoplasty and life-style intervention, including cognition guide, proper diet, weight control, stopping smoking or drinking, and exercise. The control group received uvulopalatopharyngoplasty only and their living was just as usual, polysomnography, body mass index （ BMI）, and symptom assessment were monitored lmonth, 6months, 12months and 24months after operation. The patients were followed up for more than 2 years. Results There was no statistical differences in life style between the two groups prior to intervention（P 〉 0.05 ）. The proportion of a healthy diet manner, cessation in alcohol and smoking, weight loss or good control in weight, moderate exercise between the two groups （93.8% ,86.4% ,69.1% ,81.5% ,87.7% in intervention group, and 11.5% ,36.8% ,21.8% ,17.2% ,9. 2% in control group） showed statistical differences after intervention（~2 = 113.80,43.33,37.97,69.33,103.70, respectively; P 〈 0. O1 ） . Compared to the control group, patients in intervention group had a significant improved in lowest oxygen saturation （LSaO2 ）, apnea hypopnea index （AHI）, snoring index and BMI at 6, 12, 24 months after intervention（ t = 2.51,4. 13,7.88 ;2.10,2.66,3.68 ;3.42,4. 17, 9.34 ;5.92,12.78,9.37 ; respectively ; P 〈 0. 01 ）. The observational index in intervention group before and after intervention showed statistical differences（P 〈0. 01） while no difference in control group（P 〉0. 05）. Conclusions It can improve the clinical symptoms and improve the long-term efficacy of surgical treatment to reduce cardiovascular and cerebrovascular complications for uvulopalatopharyngoplasty and life-style intervention on the patients with obstructive sleep apnea-hypopnea syndrome, which not only improves the life quality of the patients, but also reduce their economic burden. It is worthy of clinical application.