持续气道正压通气、口腔矫治器和体育锻炼治疗阻塞性睡眠呼吸障碍低通气综合征疗效比较

Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training on obstructive sleep apnea hypopnea syndrome

目的:对比分析持续气道正压通气(CPAP)、口腔矫治器(OA)和体育锻炼治疗阻塞性睡眠呼吸障碍低通气综合征(OSAHS)的疗效差别。方法:根据纳入/排除标准,选取OSAHS患者63例,随机分成CPAP治疗组(n=19)、OA治疗组(n=21)和体育锻炼组(n=23)等3组,分别给予3个月的CPAP治疗、OA治疗或体育锻炼。对比分析患者治疗前后的多导睡眠图(PSG)监测结果,血液学指标检查和日间嗜睡评分量表(ESS)等的变化。结果:相比治疗前,CPAP组和OA组治疗3个月后的呼吸暂停低通气指数(AHI)明显降低(P<0.01),睡眠潜伏期缩短(P<0.05),觉醒时间缩短(P<0.05),微觉醒指数均降低(P<0.05),睡眠平均Sp O2提高(P<0.05)。体育锻炼组患者锻炼后与锻炼前相比,ESS评分降低(P<0.05),其他指标锻炼前后的差异无统计学意义(P均>0.05)。但体育锻炼组患者血液相关指标变化明显,主要是白细胞降低,胆固醇降低,极低密度脂蛋白降低,甘油三酯降低等(P均<0.05)。结论:持续气道正压通气和口腔矫治器均可以降低呼吸暂停低通气指数等睡眠指标;体育锻炼仅能改善OSAHS患者的白日嗜睡症状和一些血液学指标,单独疗效不明显。

Objective： To compare the effects of continuous positive airway pressure （CPAP）～ oral appliance （OA） and exercise training for the treatment of obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods：Sixty-three patients with OSAHS and body mass indices less than 28 kg/m2 were randomly divided into 3 groups：CPAP （n=19）, OA （n=21） and exercise training （n=23）. Polysomnography （PSG）, blood samples and Epworth sleepiness scale （ESS） were obtained before and after 3 months of physical exercise or treatment with CPAP or OA. Results：After treatment with CPAP or an OA, the patients were presented with reductions in the apnea-hypopnea index （AH1）, sleep latency, awakening time and arousal index, and increase in the average sleep SpO2. No changes in the sleep parameters were observed in the physical exercise group. However, this group was presented with reductions in the following parameters： white blood cell, cholesterol, very- low-density lipoprotein and triglycerides. Three months of exercise and training was found to have a positive efficacy on subjective daytime sleepiness of ESS. Conclusion：CPAP and OA can reduce some sleepy indicators, such as apnea hypopnea index. Physical exercise and training, if achieved, could improve somnolence and blood indicators of the oatients, but physical trainin～ alone is not sufficientlv effective.