阻塞性睡眠呼吸暂停低通气综合征患者不同刺激率ABR结果分析

An Analysis of Auditory Brainstem Responses at High Stimulate Rate in Patients with OSAHS

目的探讨高刺激率ABR对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者听力评估的价值及其与低氧血症的相关性。方法对39例(78耳)OSAHS患者(中度5例、重度34例)和34例(68耳)正常成年人分别进行11.1、31.1、51.1次∕秒刺激率的听性脑干反应(ABR)测试,比较组间结果,并与多导睡眠监测呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、氧饱和度≤90%的时间占总监测时间的百分比(SIT90)、氧饱和度≤80%的时间占总监测时间的百分比(SIT80)进行相关性分析。结果在11.1次∕秒刺激率时OSAHS组ABR波Ⅴ潜伏期(5.79±0.22ms)较对照组(5.67±0.24ms)延长;31.1次∕秒刺激率时OSAHS组ABR波Ⅰ潜伏期(1.85±0.18ms)、波Ⅴ潜伏期(5.98±0.19ms)均较对照组(分别为1.76±0.16ms、5.82±0.24ms)延长;在51.1次∕秒刺激率时OSAHS组ABR波Ⅰ潜伏期(1.94±0.26ms)、波Ⅴ潜伏期(6.09±0.25ms)较对照组(分别为1.83±0.15ms、5.99±0.24ms)延长。刺激率由11.1次∕秒升高至31.1次∕秒时,OSAHS组波Ⅰ潜伏期延长,ΔⅠ_(31.1-11.1)(0.12±0.17ms)较对照组(0.07±0.11ms)长,刺激率由11.1次∕秒升高至51.1次∕秒时,OSAHS组波Ⅰ潜伏期延长,ΔⅠ51.1-11.1(0.21±0.25ms)较对照组(0.15±0.10ms)长。ΔⅠ_(31.1-11.1)与LSaO2负相关(r=-0.24),与SIT90(r=0.23)、SIT80(r=0.27)正相关;ΔⅠ51.1-11.1与LSaO2(r=-0.33)、MSaO2(r=-0.35)负相关,与SIT90(r=0.37)、SIT80(r=0.29)正相关;以上差异及相关性均有统计学意义(p<0.05)。结论高刺激率ABR可发现中度及重度OSAHS患者耳蜗及听神经近耳蜗段的损伤。

Objective To investigate the characteristics of auditory nerves and brainstem pathways,pathophysiological and nerve damages and the correlation between oxygen indexes,and the values of high stimulation ABR in patients with OSAHS.Methods Auditory brain stem responses（ABR）at rates of 11.1times/s,31.1times/s,51.1times/s were performed in both the moderate-to-severe OSAHS group（5cases of moderate and 34 cases of severe,in total of 39 cases,78ears）and the control group（34cases,68ears）.According to the characteristics of ABR,the correlation with parameters of blood oxygen was studied.Results At the rate of 11.1times/s,wave V latencies（5.79±0.22ms）in OSAHS patients were longer than that in the control group.At the rate of31.1times/s,wave V latencies（5.98±0.19ms）and waveⅠ（1.85±0.18ms）in OSAHS patients were prolongedmore than those in the control group.At the rate of 51.1times/s,wave V latencies（6.09±0.25ms）and waveⅠ（1.94±0.26ms）in OSAHS patients were longer than those in the control group.Increasing stimulation rates from11.1times/s to 31.1times/s showedΔⅠwas longer in OSAHS group（0.12±0.17ms）than in the control group（0.07±0.11ms）.Increasing stimulation rates from 11.1times/s to 51.1times/s showedΔⅠwas longer in OSAHS group（0.21±0.25ms）than in the control group（0.15±0.10ms）.All above had correlations with hypoxia.Conclusion High stimulation rates in ABR by amplifying the waveⅠ latency confirm cochlear and auditory nerve damages near the cochlear segment in patients with moderate to severe OSAHS.Therefore the study of nerve injury in OSAHS patients should take blood oxygen saturation and hypoxia percentage rather than AHI.