阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构紊乱与肝酶水平升高的相关性研究

Relationship between sleep architecture disorder and enhancement of liver enzyme levels in patients with obstructive sleep apnea hypopnea syndrome

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的睡眠结构紊乱及其对肝酶水平的影响。方法研究2010—2013年苏州大学附属第二医院神经内科收治的多导睡眠监测(PSG)确诊的OSAHS组和对照组的睡眠参数,且根据睡眠呼吸暂停和(或)低通气指数(AHI)将OSAHS组分为轻、中、重度三组,比较各组间肝酶及睡眠结构的变化,并将肝酶水平与睡眠结构指标进行相关性分析。结果与对照组比较,OSAHS组患者的AHI、呼吸相关微觉醒指数、最长呼吸暂停时间、睡眠时间1+2期比例及血清丙氨酸转氨酶(ATL)、天冬氨酸转氨酶(ASL)、血清γ-谷氨酰转肽酶(γ-GGT)水平显著增高,最低血氧饱和度(L-SaO2)及慢波睡眠比例显著降低(均P<0.05)。OSAHS组各亚组间比较,AHI差异有统计学意义;与重度亚组比较,轻、中度亚组呼吸相关微觉醒指数、最长呼吸暂停时间、睡眠时间1+2期比例、慢波睡眠比例及血清ATL、ASL的变化均有统计学意义;与重度亚组比较,轻度亚组的血清γ-GGT显著升高(P<0.05)。偏相关分析显示,血清ALT、AST与睡眠1+2期比例呈正相关,血清ALT与慢波睡眠比例呈负相关,与呼吸睡眠微觉醒呈正相关(均P<0.05)。结论 OSAHS患者存在睡眠结构紊乱及肝脏损伤,其肝酶水平的升高与睡眠结构紊乱有关。

Objective To investigate the influences of sleep architecture disorder on serum liver enzyme levels in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods We analyzed the sleep parameters of OSAHS pa- tients and the controls diagnosed with polysomnography （PSG） in our hospital. Based on the results of the apnea-hypopnea index （AHI） ,OSAHS patients were divided into 3 subgroups （mild,moderate and severe, respectively）. Serum liver en- zymes and sleep structures were compared between different groups. Correlation analysis was performed between the serum levels of liver enzymes and sleep structure. Results In OSAHS group, AHI, oxygen desaturation index （ ODI）, percentage of oxygen saturation 〈 90% of total recording time （Ts90%）, respiration relevant microarousal,longest time of apnea, pro- portion of NREM stage 1 ＋ 2 and serum levels of ALT, AST andγ-GGT were significantly higher （ P 〈 0. 05 ） while the low- est nocturnal oxygen saturation （ L-SaO2 ） and proportion of slow-wave sleep were significantly lower （P 〈 0.05 ） than those in the controls （P 〈 0. 05 ）. Among OSAHS patients, AHI was significantly different between the 3 subgroups （P 〈 0. 05）. The differences in Ts90% ,respiration relevant microarousal, the longest time of apnea and hypopnea, proportion of NREM stage 1 ＋ 2, proportion of slow-wave sleep and serum level of ALT and AST were significantly different from those in mild and moderate subgroups （P 〈 0. 05 ）. As compared with severe subgroup, serum level of γ-GGT in mild subgroup were sig- nificantly elevated （P 〈 0. 05 ）. Correlation analysis showed positive correlations between proportion of NREM stage 1 ＋ 2 and the level of ALT and AST, negative correlations between proportion of slow-wave sleep and the level of ALT, and posi-tive correlations between respiration relevant microarousal and the level of ALT. Conclusion 0SAHS patients have sleep architecture disorder and liver damage, and elevated liver enzyme levels are related to disordered sleep architecture.