吸烟与阻塞性睡眠呼吸暂停低通气综合征的相关性

Correlation of smoking and obstructive sleep apnea and hyponea syndrome

目的了解吸烟与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的相关性。方法对2009年7月1日至2012年6月30日到广西睡眠呼吸疾病诊疗中心就诊，30～65岁睡眠或睡眠呼吸疾病患者2243例行整夜多导睡眠图（PSG）检查，并采用回顾性调查问卷，了解患者的吸烟情况。按睡眠呼吸暂停低通气指数（AHI）将患者分组为OSAHS组（AHI≥15次／h）及无OSAHS组（AHI〈50次／h）。分析吸烟及吸烟量与OSAHS之间的联系。结果2243例患者中903例被排除，最终1340例纳入分析，其中OSAHS组929例，非OSAHS组411例。OSAHS组吸烟率为47．1％，非OSAHS组吸烟率为25．5％。在控制了年龄、体重、性别、饮酒史后，吸烟组患OSAHS的条件OR值为1．446（95％CI：1．079～1．939，P=02013）；重度吸烟未戒烟组（≥30包·年）患OSAHS的条件OR值为2．382（95％CI：1．127—4．375，P=0．012）。未戒烟OSAHS组比不吸烟OSAHS组有更长的缺氧时间比[（20．5±23．1）％比（15．6±18．8）％，P=0．004]及更低的血氧饱和度[（69．4±10．3）％比（73．2±9．7）％，P=0．000]，而戒烟OSAHS组与不吸烟OSAHS组间差异无统计学意义。重度吸烟OSAHS组出现夜间血氧饱和度〈90％的时间占总睡眠时间比≥5％者条件OR值是1．893（95％CI：1．046—3．423，P=0．035）。结论吸烟与OSAHS有明显的相关性；吸烟，特别是重度吸烟者OSAHS风险更高。吸烟加重了OSAHS组的夜间低氧血症。

Objective To explore the correlation between smoking and obstructive sleep apnea and hyponea syndrome （OSAHS）. Methods The data were collected from a chart review of patients with sleep or sleep-breathing disorders undergoing overnight polysomnograpghy （PSG） at Sleep-Disordered Breathing Center of Guangxi from July 1, 2009 to June 30, 2012. Smoking history was quantified by retrospective questionnaires. A definite diagnosis of OSAHS was defined by an apnea-hypopnea index （AHI） （events/b） of 〉 15 events per hour. And those with AHI （events/h） between 5 and 15 were eliminated. The non- OSAHS subjects were defined by an AHI （events/h） 〈 5 events per hour. The association of smoking status and severity with OSAHS was analyzed. Results A total of 903 patients were excluded from 2 243 patients. The recruited subjects were divided into OSAHS （ n = 929 ） and non-OSAHS （ n = 411 ） groups. Smoking prevalence in OSAHS group was 47. 1% versus 25.5% in non-OSAHS group. Logistic regression analyses were performed to examine the effects of smoking habits while adjusting for age, gender, body mass index （BMI） and drinking history. Current smokers were 1. 446 times more likely to have OSAHS than non- smokers （95% CI： 1. 079 -1. 939, P=0. 013）. Current smokers with pack-years 930 were more 2. 382 times more likely to have OSAHS than non-smokers to have OSAHS （95% CI： 1. 127 -4. 375, P = 0. 012）. Current smokers diagnosed as having OSAHS with pack-years 930 had a more percentage of total sleep time （TST） spent with saturation of oxyhemoglobin （SaO2 ） 〈 90% （（20. 5 ± 23. 1 ）% vs （15.6 ±18. 8） %, P = 0. 004） and lower average SaO2 （ （69. 4 ± 10. 3 ） % vs （ 73.2 ± 9. 7） %, P = 0. 000） during sleep than non-smokers diagnosed as having OSAHS. Current smokers diagnosed as having OSAHS with pack-years≥30 were 1. 893 times more likely to spend 〉 5% of TST at SaO2 〈 90% than non-smokers diagnosed as having OSAHS （95% CI： 1. 046 -3. 423, P = 0. 035）. Conclusions Smoking is associated with a significantly increased risk of OSAHS and nocturnal hypoxia in current smokers, especially those with ≥30 pack-years. And it exacerbates nocturnal hypoxia in OSAHS patients.