中重度阻塞性睡眠呼吸暂停综合征临床表现的聚类分析及其意义

Cluster analysis of the clinical presentations in patients with moderate-to-severe obstructive sleep apnea syndrome and its significance

目的对中重度阻塞性睡眠呼吸暂停综合征（OSAS）患者的临床表现进行聚类分析，并探讨其意义。方法 对2012年10月至2015年10月在湖北省人民医院呼吸内科诊断为OSAS的成年中重度患者临床表现进行回顾性分析，将15项临床表现纳入聚类分析，聚类完成后分析各类的特点。结果 共1 008例患者，分别被聚类为日间嗜睡组、夜间失眠组、轻微症状组三组，各占450例（44.64%）、351例（34.82%）、207例（20.54%）。日间嗜睡组白天嗜睡、疲劳、情绪急躁的发生率及Epworth嗜睡量表评分最高[分别为329例（73.11%）、280例（62.22%）、223例（49.56%）及（13.50±4.93）分]。夜间失眠组失眠、夜间多尿、盗汗、呼吸暂停、憋醒的发生率最高[分别为177例（50.43%）、157例（44.73%）、130例（37.04%）、296例（84.33%）、182例（51.85%）]，轻微症状组缺乏典型OSAS症状，但更易有相关合并症，合并高血压、冠心病、心律失常、慢阻肺、胃食管反流分别占118例（57.00%）、41例（19.81%）、44例（21.26%）、34例（16.43%）、38例（18.36%）；以上结果均显著大于另外两组（均P〈0.012 5）。轻微症状组合并糖尿病者28例（13.53%），也大于其他两组但差异无统计学意义。结论 聚类分析可以给OSAS患者复杂的临床表现分类，这对认识疾病的异质性和早期诊治有重要的意义。

ObjectiveTo analyze subtypes of the clinical presentation of moderate-to-severe obstructive sleep apnea syndrome （OSAS） by cluster analysis and to explore its significance.MethodsA retrospective analysis was performed on the data of adult moderate-to-severe OSAS patients, which were diagnosed in Respiratory Department, Renmin Hospital of Wuhan University from October 2012 to October 2015. Fifteen kinds of clinical presentations were included in the cluster analysis, and analysis of characteristic of each cluster was then performed after category.ResultsPatients were classified as three distinct clusters. They were identified as ＂daytime sleepiness group＂ , ＂night insomnia group＂ and ＂minimally symptomatic group＂ , consisting of 450 cases （44.64%）, 351 cases （34.82%） and 207 cases （20.54%） of the entire cohort. Members in daytime sleepiness group had the highest probability of daytime sleepiness, tiredness, irritableness and the highest Epworth Sleeping Scale score[329 cases （73.11%）, 280 cases （62.22%）, 223 cases （49.56%） and （13.50±4.93） points], members in night insomnia group had the highest probability of complaining of insomnia, nocturia, night sweats, apnea and awakening[177 cases （50.43%）, 157 cases （44.73%）, 130 cases （37.04%）, 296 cases （84.33%）, 182 cases （51.85%）], the probability of having typical symptoms above was the lowest in minimally symptomatic group, but these patients were more likely to have related comorbidities： hypertension, coronary heart disease, arrhythmia, chronic obstructive pulmonary disease and gastroesophageal reflux disease[118 cases （57.00%）, 41 cases （19.81%）, 44 cases （21.26%）, 34 cases （16.43%）, 38 cases （18.36%）]; all above results were significantly higher than the other two groups （P〈0.012 5）. The rate of diabetes in minimally symptomatic group[28 cases （13.53%）]was also higher but the difference was not statistical significance.ConclusionCluster analysis contributes to classify multiple clinical presentations of OSAS patients, which has important significance for recognizing disease heterogeneity and early diagnosis.