阻塞性睡眠呼吸暂停低通气综合征与年龄对睡眠结构的影响

Effects of obstructive sleep apnea-hypopnea syndrome and age on sleep architecture

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与年龄分别对睡眠结构的影响及持续气道正压通气(CPAP)的治疗效果。方法回顾性分析222例因睡眠打鼾行多导睡眠监测(PSG)的患者,并于次日在PSG下行CPAP治疗,分别控制呼吸暂停低通气指数(AHI)及年龄后,比较不同年龄组以及不同严重度OSAHS组的睡眠结构,并比较OSAHS患者CPAP治疗后睡眠结构、通气功能的变化。结果 N3睡眠与AHI的相关性最大(r=-0.361),REM睡眠及睡眠觉醒与年龄的相关性最大(r=-0.211,0.216)。四年龄组的AHI无显著差异下(P=0.185),睡眠效率、N1、N2及REM睡眠、睡眠觉醒差异有统计学意义(P<0.001,P=0.015,0.013,0.030,0.001)。随年龄增加,REM睡眠减少,睡眠觉醒增加。控制AHI后,睡眠效率及睡眠结构差异有统计学意义。不同严重度OSAHS组中,控制年龄后,患者的N1、N2及N3睡眠差异有统计学意义(P=0.011,0.017,0.001)。中重度OSAHS患者N3睡眠随AHI增加而减少。OSAHS患者CPAP治疗后,N1及N2睡眠显著减少,N3及REM睡眠显著增加,所有P<0.001。结论 OSAHS与年龄相比,REM睡眠及睡眠觉醒受年龄影响较大,N3睡眠受OSAHS影响较大,CPAP治疗可改善OSAHS患者的睡眠。

Objective To investigate the effects of obstructive sleep apnea- hypopnea syndrome（OSAHS） and age on sleep architecture and the therapeutic effects of continuous positive airway pressure（CPAP）. Methods We retrospectively analyzed222 subjects undergoing polysomnography（PSG） for snoring, who received CPAP under PSG on the next day following the initial PSG. The sleep architecture of the subjects in different age groups and in groups with different severities of OSAHS was analyzed before and after adjustment for apnea-hypopnea index（AHI） or age. The sleep architecture and ventilation function of the patients with OSAHS were also analyzed after CPAP. Results N3 sleep showed the strongest correlation with AHI（r=-0.361）, and REM sleep and wake after sleep onset（WASO） were the most strongly correlated with age（r=- 0.211 and 0.216,respectively）. The 4 age groups showed significant differences in sleep efficiency（P〈0.001）, N1（P=0.015）, N2（P=0.013） and REM（P=0.030） sleeps, and WASO（P=0.001） but not in AHI（P=0.185）. REM sleep decreased and WASO increased with an increasing age. The sleep efficiency and architecture were still significant different after adjustment for AHI. In 4 groups with different severity of OSAHS, N1, N2 and N3 sleeps were significant different after adjustment for age（P=0.011, 0.017, 0.001）. In patients with moderate or severe OSAHS, N3 sleep increased with the increase of AHI. After CPAP for OSAHS, N1 and N2 sleeps significantly decreased, and N3 and REM sleeps increased（P〈0.001）. Conclusions Between OSAHS and age, REM sleep and WTSO are more importantly affected by age, while OSAHS more strongly affects N3 sleep. CPAP can improve the sleep quality of patients with OSAHS.