妊娠期阻塞性睡眠呼吸暂停低通气综合征诊治的初步研究

Clinical analysis of maternal-fetal outcome of obstructive sleep apnea hypopnea syndrome patients diagnosed during pregnancy

目的探讨妊娠期阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)的诊断、治疗及预后,为临床提供依据。方法选择2008年5月至2011年10月北京大学人民医院妇产科有打鼾或OSAHS高危因素的妊娠妇女,经夜间动态血氧饱和度(SaO2)和/或多导睡眠图(poly-somnography,PSG)检查确诊为OSAHS的患者12例,记录其母儿结局。结果 12例妊娠合并OSAHS患者均有打鼾症状,8例妊娠前体质指数(body mass index,BMI)≥25kg/m2,其中1例有OSAHS家族史,1例合并甲状腺功能减退,10例合并妊娠期高血压疾病。在知情同意的情况下,10例患者接受了持续气道正压通气(continuous positive airway pressure,CPAP)治疗,依从性良好。治疗前后进行SaO2监测,治疗前后平均SaO2(MSaO2)分别是(96.29±0.63)%和(94.32±1.14)%(P<0.001),最低SaO2(LSaO2)分别是(89.5±5.28)%和(80.85±9.42)%,两者治疗后均较治疗前有显著升高(P<0.05);同时每小时SaO2下降≥4%的次数[(0.96±1.00)次/h]较治疗前[(11.16±12.06)次/h]有显著下降(P<0.05)。早产5例,足月产5例,因妊娠期高血压疾病加重未进入围生期2例;并发妊娠期糖尿病6例,产后出血2例。10例活产儿平均出生体质量为(3231.7±702.5)g(1500～4070)g,其中9例在诊断OSAHS后采取了CPAP治疗,均无胎儿生长受限和新生儿窒息的发生,5例早产儿和1例37周足月儿出生后低血糖转儿科治疗。结论妊娠期妇女尤其是有OSAHS高危因素者,详细询问病史并注意是否有OSAHS的症状,一旦怀疑OSAHS,需要行整夜SaO2监测或PSG检查。OSAHS患者中妊娠期高血压疾病、妊娠期糖尿病和早产的发生率较高。CPAP是一种安全有效的治疗妊娠期OSAHS的方法。

Objective To explore the clinical characteristics of obstructive sleep apnea-hypopnea syndrome （OSAHS） diagnosed during pregnancy. Methods Data of 12 patients with OSAHS diagnosed by nocturnal blood oxygen saturation （SaO2） monitoring and polysomnography （PSG） during pregnancy from May 2008 to Oct 2011 at Peking University People’s Hospital were analyzed retrospectively.Results All the 12 patients were snorers, one with OSAHS family history, one with hypothyroidism, the other 10 with hypertensive disorders complicating pregnancy （HDCP）,8 cases with BMI≥25 kg/m2 before pregnancy. Ten patients received continuous positive airway pressure （CPAP ） treatment with good compliance under informed consent. The mean SaO2 （MSaO2） and the lowest SaO2 （LSaO2） during sleep after treatment had significantly increased than that of before treatment （96.29±0.63） % vs （94.32±1.14 ）%（ P〈0.001）, （89.5 ±5.28 ）% vs（ 80.85±9.42 ）% （P〈0.05）;while the number of oxygen desaturation ≥4% per hour （DI4） significantly decreased （0.96±1.00 vs 11.16±12.06, P〈0.05）.Two pregnency ended before 28 gestational weeks due to exacerbated HDCP. The case number of preterm labor, concurrent gestational diabetes and postpartum hemorrhage were 5, 6 and 2,respectively. The average weight of 10 live births were （3 231.7±702.5）g （1 500～4 070）g, nine patients had taken CPAP therapy after thediagnosis of OSAHS, there were no fetal growth retardation nor neonatal asphyxia, 5 premature newborns and one term newborn with hypoglycemia were transferred to NICU. Conclusions Pregnant women who have OSAHS risk factors should be paid attention to during the perinatal care and nocturnal SaO2 monitoring or PSG should be performed in the suspected OSAHS patients. The incidence of HDCP, gestational diabetes mellitus and preterm labor were relatively high in OSAHS patients. CPAP was a safe and effective treatment to OSAHS patients in pregnancy.