阻塞性睡眠呼吸暂停低通气综合征患者摄氧效率与运动耐力的相关性研究

Association of oxygen uptake efficiency in exercise test with exercise capacity in patients of obstructive sleep apnea hypopnea syndrome

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的摄氧效率特点,并分析摄氧效率与OSAHS患者疾病严重程度的相关性.方法 将2010年7月至2013年10月在上海市肺科医院呼吸科就诊的OSAHS患者30例作为OSAHS组,其中男24例,女6例,年龄32 ～ 75岁;同年龄段的健康志愿者25名作为正常对照组.对所有受试者进行常规肺功能、心脏超声、多导睡眠图和斜坡式功率递增症状限制性心肺运动试验测定,采用实时呼吸法对呼吸交换参数进行收集和分析.计数资料用构成比标识,两组间比较采用t检验和x^2检验,相关性分析采用Pearson相关性检验.结果 OSAHS组峰值摄氧量（peak VO2）及峰值摄氧量占预计值百分比（peak VO2％ pred）分别为（18±4）L/min和（68±14）％,显著低于对照组[（28±6）L/min和（84±16）％],差异均有统计学意义（￡值分别为7.13和4.23,P值均＜0.01）.OSAHS组摄氧效率斜率（OUES）、摄氧效率平台（OUEP）和无氧域时的摄氧效率（OUE@AT）分别为（1.8±0.4）L·min^-1·g^-1、（31±5） ml/L和（30±5） ml/L,均显著低于正常对照组（2.3 ±0.5）L·min^-1·g^-1、（36±4） ml/L和（36±4） ml/L,差异均有统计学意义（t值为3.78 ～ 4.49,均P＜0.01）.OSAHS组的OUES、OUEP和OUE@AT与peak VO2％pred呈显著正相关（r值为0.53 ～0.67,均P＜0.01）.OSAHS组的OUES、OUEP和OUE@AT与呼吸暂停低通气指数（AHI）呈显著负相关（r值为-0.67～-0.54,均P＜0.01）.结论 OSAHS患者的摄氧效率显著低于健康人,且与患者的疾病严重程度呈显著负相关.

Objective To explore the characteristics of oxygen uptake efficiency （OUES） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and analyze the relationship between OUE and severity of disease.Methods Pulmonary function test,polysomnogram and cardiopulmonary exercise testing were performed in 35 patients with OSAHS and 25 age-matched healthy volunteers.Their successive breathing respiratory exchange parameters were collected and analyzed.And t and x2 tests were used for 2 sample comparison.Correlation analysis was performed by Pearson correlation test.Results Significant differences in peak VO2 and peak VO2 % pred existed between OSAHS and normal control groups [（18±4） vs.（28 ±6） L/min,P〈0.01;（68±14） vs.（84±16） %,P〈0.01].Compared with normal control group [（2.3 ±0.5） L· min^-1 ·g^-1 ; （36 ±4） ml/L; （36 ±4） ml/L],OUES,OUEP and OUE@AT of OSAHS group [（1.8 ± 0.4） L ·min^-1 ·g^-1 ; （31 ± 5） ml/L; （30 ± 5） ml/L] were significantly lower （t =3.78-4.49,all P 〈0.01）.And OUES,OUEP and OUE@AT in OSAHS patients were correlated （r =0.53-0.67,all P 〈0.01） positively with exercise tolerance （peak VO2% pred） while negatively with apnea hypopnea index （AHI） （r=-0.67-0.54,all P 〈0.01）.Conclusion The oxygen uptake efficiency of patients with OSAHS is significantly reduced compared to that of normal subjects.And it is correlated negatively with severity of disease.