复杂性睡眠呼吸暂停综合征患者临床特征及适应性伺服通气的治疗效果

Clinical characteristics and adaptive servo-ventilation treatment outcomes of complex sleep apnea syndrome

目的观察复杂性睡眠呼吸暂停综合征(Comp SAS)的临床特征,评价适应性伺服通气(ASV)对Comp SAS的疗效。方法收集接受持续气道正压通气(CPAP)治疗的成年中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者303例。根据指南将303例患者分为单纯OSAHS组和Comp SAS组。Comp SAS组患者进行ASV治疗。比较两组患者的年龄、性别、体重、体质指数、合并症及诊断性多导睡眠图监测参数及呼吸机治疗时参数。结果接受CPAP治疗的成年中重度OSAHS患者中,Comp SAS患者所占比例为6.2%。Comp SAS组患者高血压发生率为73.6%,心力衰竭的发生率为26.3%,均高于单纯OSAHS组患者的42.9%和7%(P<0.05)。与治疗前相比,经CPAP治疗的Comp SAS组患者中枢性睡眠呼吸暂停指数(CAI)明显升高(P<0.05),分别为(9.50±2.94)次/h vs(2.95±2.88)次/h;Comp SAS组患者ASV治疗与CPAP治疗相比,前者睡眠效率明显提高,Ⅲ期睡眠所占比例明显升高;呼吸暂停低通气指数(AHI)、CAI明显降低;LSp O2显著增加。结论 Comp SAS患者中高血压、心力衰竭的发生率更高,混合性睡眠呼吸暂停指数更高。与CPAP相比,ASV治疗更能有效增加Comp SAS患者深睡眠,降低AHI和CAI,纠正低氧血症。

Objective To observe the characteristics of complex sleep apnea syndrome（ Comp SAS） and to evaluate the therapeutic outcomes of adaptive servo-ventilation（ ASV） on patients with Comp SAS.Methods 303 adult patients underwent continuous positive airway pressure（ CPAP） titration for moderate-severe obstructive sleep apnea-hypopnea syndrome（ OSAHS） were prospectively studied.Patients were divided into simple OSAHS group and Comp SAS group.The Comp SAS group was then treated with ASV.Age,gender,weight,BMI,comorbidities were all recorded as well as sleep efficiency,sleep structure,events,lowest oxygen saturation（ LSa O2） by polysomnograph（ PSG） for the first night and during CPAP titration and ASV therapy,respectively.Results Nineteen（ 6.2%） out of the 303 patients under CPAP treatment met the criteria of Comp SAS.Prevalence of hypertension（ 73.6%） and congestive heart failure（ 26.3%） in patients with Comp SAS were higher compared to simple OSAHS patients（ 42.9% and 7%,P 0.05）.Central apnea index（ CAI） in Comp SAS group was increased by CPAP treatment [（ 9.50 ± 2.94） / h] compared to that before CPAP titration [（ 2.95 ± 2.88） / h]（ P 0.05）.Sleep efficiency,stage Ⅲ sleep proportion and LSa O2 were increased with ASV therapy in patients with Comp SAS,while AHI and CAI were decreased compared to that with CPAP titration.Conclusion Comp SAS patients had higher prevalence of hypertension and congestive heart failure and higher MAI on PSG.Compared with CPAP,ASV therapy may better improve sleep quality,reduce AHI and CAI,and control hypoxemia for patients with Comp SAS.