阻塞性睡眠呼吸暂停低通气综合征患者睡眠状态下脑氧饱和度观察

Cerebral oxygenation during sleep in patients with obstructive sleep apnea-hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者睡眠期间脑组织氧合变化。方法选取因夜间睡眠时打鼾并疑有睡眠呼吸障碍就诊行睡眠监测患者73例,受试者进行多导睡眠呼吸监测同时行脑局部氧饱和度(rSO_2)监测,持续时间7 h。依据整晚睡眠监测所得呼吸暂停低通气指数(apnea hypopnea index,AHI)将受试者分为4组,分析清醒与睡眠期及不同睡眠时相rSO_2是否存在差异。结果共49例受试者完成研究。(1)所有受试者脉搏氧饱和度(SpO_2)和rSO_2在清醒状态下分别为(96.44±1.07)%、(66.32±1.65)%,睡眠期间分别降至(93.74±2.86)%、(64.98±2.00)%,P<0.001,各组从清醒到睡眠期,SpO_2、rSO_2呈现出相似的降低趋势。(2)中度OSAHS组睡眠期SpO_2低于AHI正常组、轻度OSAHS组(P<0.05、P<0.01);重度OSAHS组清醒期SpO_2及睡眠期SpO_2、rSO_2均低于其他3组(P均<0.05)。(3)中、重度OSAHS患者SpO_2、rSO_2下降幅度在快动眼睡眠期大于非快动眼睡眠期(中度OSAHS组P<0.05,重度OSAHS组P<0.001)。(4)各睡眠时相脑氧饱和度下降幅度与脉搏氧饱和度下降幅度显著相关(非快动眼睡眠期r=0.911,P<0.001;快动眼睡眠期r=0.872,P<0.001)。结论因反复发生呼吸暂停及低通气致OSAHS患者睡眠期脑氧饱和度低于清醒期。近红外线光谱技术为评价OSAHS患者睡眠期间脑组织氧供需平衡提供了无创、有效的监测方法。

Objective To investigate the changes of cerebral tissue oxygenation in patients with obstructive sleep apnea-hypopnea syndrome. Methods Seventy three subjects were selected, who were referred for nocturnal snoring and suspected with obstructive sleep apnea-hypopnea syndrome. All subjects underwent full night polysomnography coupled with cerebral near-infrared spectroscopy recording for seven hours. According to the apnea hypopnea index, the subjects were divided into four groups. The results of cerebral oxygen saturation monitoring were compared between wakefulness and sleep, and between different sleep stages. Results Forty nine subjects completed the study. During wakefulness, mean pulse oxygen saturation was 96.44±1.07% and mean cerebral oxygen saturation was 66.32±1.65%, the two indica- tors decreased to 93.74＋2.86% and 64.98＋2.00% respectively during sleep（P 〈 0.001）. The mean SpO2 in sleep was lower in the moderate group compared to the control and mild group （P 〈 0.05, P 〈 0.01 ）. In severe OSAHS patients, the mean SpO2 during awake, SpO2 and rSO2 in sleep were significantly lower than those in other groups（all P 〈 0.05）. Changes in peripheral capillary and cerebral oxygen saturation were more remarkable during rapid eye movement （REM） sleep than non-REM sleep in patient with moderate to severe OSAHS（P 〈 0.05, P 〈 0.001）. Decreases in cerebral oxygen saturation had significant correlations with pulse oxygen saturation dips during different sleep stages （non-REM sleep r = 0.911, P 〈 0.001, REM sleep r = 0.872, P 〈 0.001 ）. Conclusion Cerebral oxygen saturation during sleep was is lower than that in wakefulness because of repeated apnea and hypopnea. Near-infrared spectroscopy is a noninvasive and effective tool to evaluate brain tissue oxygenation in OSAHS.