肥胖低通气综合征在阻塞性睡眠呼吸暂停低通气综合征患者中的发病特征及预测因素分析

Analysis of characteristics and predictors of obesity hypoventilation syndrome in patients of obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者中肥胖低通气综合征（OSH）的发病特征和预测OSH发病的相关因素。方法根据BMI和动脉血气分析结果，将266例经多导睡眠监测明确诊断为OSAHS的患者分为3组：非肥胖OSAHS组85例、肥胖OSAHS组138例和OHS组43例，比较3组患者BMI、呼吸频率、颈围、心率等一般资料和多导睡眠监测参数，对肥胖OSAHS组和OHS组患者行肺功能检查并对其结果进行比较。对OHS发生的相关因素进行多元Logistic回归分析。结果OHS组患者BMI、呼吸暂停低通气指数（AHI）、颈围、呼吸频率、心率、血氧饱和度〈90％时间占睡眠总时间的百分比（Ts90％）明显高于其他两组OSAHS患者（P〈0．05），而夜间最低氧饱和度（LSaO2）则低于其他两组（P〈0．05），OHS组白天PaO2、1秒钟用力呼气容积占预计值的百分比（FEV，％）、用力肺活量占预计值的百分比（FVC％）及肺总量占预计值的百分比（TLC％）明显低于肥胖OSAHS组（P〈0．05）。多元Logistic回归分析显示，呼吸频率的加快、BMI的增高和Ts90％的降低与OHS的发生有显著相关性。结论OHS患者睡眠节律紊乱、缺氧现象更为严重，OSAHS患者呼吸频率加快、BMI增高和Ts90％降低对OHS的发病有预测价值。

Objective To explore characteristics and predictors of obesity hypoventilation syndrome（OHS） in patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods According to BMI and results of arterial blood gas analysis, 266 OSAHS patients diagnosed by polysemnogram were divided into 3 groups including the nonobese OSAHS group （85 eases）, the obese OSAHS group （138 cases） and the OHS group（43 cases）. BMI,respiratory rate, neck circumference, heart rate etc. and parameters of polysomnogram were compared in the three groups. Pulmonary function were conducted and their results were compared in obese OSAHS group and OHS group. Multivariate logistic regression analysis was conducted to evaluate the related factors of OHS. Results In OHS group, BMI, apnea hypopnea index （AHI）, neck circumference, respiratory rate and heart rate were higher than other groups while Ts90% was lower （ P 〈 0. 05 ）. PaO2,FEV, %, FVC% and TLC% of the OHS patients were lower than those of the obese OSAHS patients（P 〈0. 05）. Multivariate logistic regression analysis showed that increased respiratory rate and BMI and well as decreased Ts90% were significantly related with OILS. Conclusion High prevalence of OHS is confirmed in OSAHS patients. OHS patients experience more sleep disturbance and hypoxia phenomena. Increased respiratory rate and BMI and well as decreased Ts90% may be predictors of OHS.