OSAHS 患者视网膜神经纤维层厚度的研究

Research of retinal nerve fiber layer thickness in patients with obstructive sleep apnea hyponea syndrome

目的：评估 OSAHS 患者视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度变化。方法收集2014年6~10月于秦皇岛市第一医院初次应用多导睡眠监测仪诊断 OSAHS 患者共30例,选取健康体检患者15例,年龄30~50岁,无视野缺损,进行病例对照研究。应用光学相干断层成像（optical coherence tomography,OCT）测量患者视网膜神经纤维层厚度来评估 OSAHS 的 RNFL情况。结果与正常对照组比较,OSAHS 患者平均视网膜神经纤维层厚度降低,且差异有统计学意义,对照组（121.5±7.9）μm,OSHSA 组（116.3±8.3）μm （P 〈0.01）,同样鼻侧也是降低的, OSAHS （70.4±3.8）μm,对照组（70.7±6.7）μm （P 〈0.05）。而上侧 OSAHS 组（140.2±8.3）μm,对照组（140.0±9.0）μm （P 〉0.05）,下侧 OSAHS 组（140.5±8.3）μm,对照组（140.3±7.5）μm （P 〉0.05）,颞侧 OSAHS 组（72.5±6.2）μm,对照组（72.2±5.3）μm 差异无统计学意义（P 〉0.05）。根据呼吸暂停低通气指数（apnea hypopnea index,AHI）将患者分为三组,重度OSAHS 患者较轻度、中度 OSAHS 患者 RNFL 平均值明显降低（P 〈0.01）,而轻度与中度组比较差异无统计学意义（P 〉0.05）。而三组患者上侧、下侧及颞侧 RNFL 差异无统计学意义。OSAHS 组黄斑厚度（173.3±4.7μm）与对照组比较（173.3±4.6）μm 变化不明显（P 〉0.05）。OSAHS 组与对照组黄斑体积差异无统计学意义,分别为（6.9±0.3）mm3,（6.8±0.3）mm3（P 〉0.05）。OSAHS患者 AHI 与 RNFL 呈负相关（r =-0.554,P 〈0.01）。夜间最低血氧饱和度与 RNFL 平均值成正相关（r =0.510,P 〈0.01）。结论 OSAHS 患者 RNFL 厚度平均值及鼻侧是降低的,RNFL 厚度与AHI 呈负相关,与夜间最低血氧饱和度呈正相关。

Objective To assess the peripapillary retinal nerve fiber layer （RNFL） thickness in patients affected by obstructive sleep apnea-hypopnea syndrome （OSAHS）.Methods This prospective, observation case-control study consisted of 60eyed of 30 OSAHS patients which diagnosed first from the first hospital of qinhuangdao from June 2014 to October.Results OSAHS patients showed a significant reduction of the average,controls （121.5 ± 7.9）μm,OSHSA （1 1 6.3 ± 8.3）μm （P 〈0.01） and nasal quadrant.OSAHS（70.4±3.8）μm,controls （70.7±6.7）μm （P 〈0.05） RNFL thickness.There was no differences in superior,inferior and temporal quadrant RNFL thickness.The average of severe OSAHS patients thinner than mild and moderate （P 〈 0.01）.No differences in macular thickness and volume were observed between OSAHS patients and controls.There was negative correlation between AHI and RNFL thickness （r =-0.554,P 〈0.01） and positive correlation between the lowest oxygen saturation and RNFL thickness （r = -0.5 10,P 〈 0.01）.Conclusions RNFL thickness of OSAHS patients is reduced.There is negative correlation between AHI and RNFL thickness and positive correlation between the lowest oxygen saturation and RNFL thickness.