不同年龄组睡眠呼吸暂停低通气综合征患者临床特点及持续气道正压通气治疗依从性分析

Clinical feature and compliance with continuous positive airway pressure in obstructive sleep apnea hypopnea syndrome patients at different ages

目的探讨不同年龄组睡眠呼吸暂停低通气综合征（OSAHS）患者临床特点、多导睡眠监测（PSG）特点及持续气道正压通气（CPAP）治疗情况差异。方法回顾性地分析2012年1月至2013年7月在滨州医学院附属医院睡眠呼吸监测中心经PsG诊断为OSAHS的220例患者的临床资料，按年龄分为青年组（10～44岁）89例、中年组（45～59岁）72例及老年组（≥60岁）59例，收集临床资料、调查问卷、嗜睡评分及PSG资料。对睡眠呼吸暂停低通气指数（AHI）≥30的154例OSAHS患者进行6个月、9个月及1年的随访，共有129例患者接受CPAP治疗。结果老年组患者与青年组患者相比夜间深睡眠比值降低（P〈0．05），Epworth嗜睡评分更高（P〈O．01）。老年组患者AHI低于体质量指数（BMI）相匹配的青年组患者（P〈0．05），但夜间呼吸暂停严重程度较重（P〈0．05）。老年组患者中枢性睡眠呼吸暂停发生的比率高于另外两组（P〈0．05）。在使用CPAP治疗的第6个月、9个月及1年时，仍能保持较好依从性的老年组患者分别为90％，86％和82％，中年组为89％，87％和79％，在青年组为87％，74％和69％。老年组患者接受CPAP治疗的依从性较好（P〈0．05）。结论老年组患者日间临床表现更重、睡眠质量更差，接受CPAP治疗依从性较好。

Objective To investigate the differences in the clinical features, polysomnographic characteristics and compliance with continuous positive airway pressure （CPAP） among elderly obstructive sleep apnea hypopnea syndrome （OSAHS） patients compared with those at young and middle ages. Methods A total of 220 PSG-diagnosed OSAHS patients in the Affiliated Hospital of Binzhou Medical College from January 2012 to July 2013 were subjected and retrospectively analyzed in this study. They were divided into the young group （aged 10 to 44 years, n = 89）, middle-aged group （aged 45 to 59 years, n = 72） and elderly group （I〉60 years old, n = 59）. The clinical data, questionnaire, Epworth sleepiness scores and polysomnographic parameters were collected and compared. The 154 patients with apnea hypopnea index （AHI） /〉30 were followed up at 6 and 9 months, and 1 year. Totally 129 patients received CPAP. The application of noninvasive ventilator was also analyzed. Results The elderly patients had lower ratio of deep sleep at night （P 〈 0.05）, and higher Epworth sleepiness scores （P 〈 0.01） when compared with young patients. They also had lower AHI than those weight-matched young patients （P 〈 0.05）, but had severe sleep apnea at night （P 〈 0.05）. The incidence of central sleep apnea was higher in the elderly group than in the other 2 groups （P 〈 0.05）. The percentages of good compliance with CPAP at 6 months, 9 months and 1 year were 90%, 86% and 82% respectively in the elderly group, and were 89%, 87% and 79% respectively in middle-aged group, and 87%, 74% and 69% respectively in young group. The elderly patients had better compliance to CPAP than the other 2 groups（P 〈 0.05）. Conclusion The elderly patients suffer more severe daily clinical manifestations, have worse sleep quality, and so, are more likely to have good compliance with CPAP.