未接受治疗的阻塞性睡眠呼吸暂停低通气综合征患者睡眠监测随访研究

Follow-up Study of Sleep Monitoring in Patients with Untreated Obstructive Sleep Apnea Hypopnea Syndrome

目的分析未接受治疗的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者7年随访前后睡眠监测的变化。方法选取2002年承德市社区人群OSAHS流行病学调查筛选的OSAHS,2009年获得完整随访,且未经手术、呼吸机等治疗的患者99例为研究对象。根据患者基线年龄,分为中年组(年龄<60岁,63例)和老年组(年龄≥60岁,36例)。记录患者主要临床表现,有无高血压、冠心病、脑血管病、糖尿病等并发症;分别于2002年、2009年进行睡眠监测,并采用Epworth嗜睡评估表(ESS)评价患者日间嗜睡程度。结果老年组憋醒发生率低于中年组,高血压、冠心病、脑血管病、糖尿病检出率高于中年组(P<0.05)。中年组2002年41例轻度OSAHS患者中,21例进展为中度,2例进展为重度;13例中度OSAHS患者中,6例进展为重度。老年组2002年10例轻度OSAHS患者中,3例进展为中度;12例中度OSAHS患者中,3例进展为重度。中年组2009年体质指数(BMI)、呼吸暂停低通气指数(AHI)、ESS评分高于2002年,睡眠期间最低动脉血氧饱和度(LSaO_2)低于2002年(P<0.05)。老年组2002年与2009年BMI、AHI、ESS评分比较,差异无统计学意义(P>0.05),2009年LSaO_2低于2002年(P<0.05)。中年组7年期间LSaO_2、AHI变化值高于老年组(P<0.01)。结论未接受治疗的中年OSAHS患者随着年龄的增长,睡眠障碍的程度逐渐加重;而未接受治疗的老年OSAHS患者随着病程延长,睡眠障碍进展趋势有所减缓,但心脑血管疾病等并发症明显增多。

Objective To analyze the changes of sleep monitoring during 7-year follow-up in patients with untreated obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods OSAHS paients were screened by the OSAHS epidemiological survey in community population of Chengde City in 2002. In 2009,99 patients with complete follow-up and without surgery,ventilator and other treatment were enrolled as study subjects. According to the baseline age, the patients were divided into middle aged group（ age 60 years old, n = 63） and the elderly group（ age ≥ 60 years old, n = 36）. The main clinical manifestations of patients, with or without hypertension, coronary heart disease, cerebrovascular disease, diabetes were recorded. Sleep monitoring was performed in 2002 and 2009,respectively. And Epworth sleepiness evaluation（ ESS） was used to assess the degree of daytime sleepiness. Results The incidence of suppress wake in elderly group was significantly lower than that in middle aged group,and the incidence of hypertension,coronary heart disease,cerebrovascular disease and diabetes in elderly group were higher than those in the middle aged group（ P〈0. 05）. Among the 41 patients with mild OSAHS in the middle aged group in 2002,21 cases progressed to moderate OSAHS and 2 progressed to severe. Among the 13 patients with moderate OSAHS,6 cases progressed to severe. Among the 10 patients with mild OSAHS in the elderly group in 2002,3 cases progressed to moderate OSAHS. Among the 12 patients with moderate OSAHS,3 cases progressed to severe. In 2009,the body mass index（ BMI）,apnea hypopnea index（ AHI） and ESS score of the middle aged group were higher than those in 2002,and LSaO_2 was lower than that in 2002（ P〈0. 05）. There were no significant differences in BMI,AHI and ESS score between the2002 and 2009 in the elderly group（ P〈0. 05）,LSaO_2 in 2009 was lower than that in 2002（ P〈0. 05）. The changes of LSaO_2 and AHI in middle aged group during 7 years were higher than those in elderly group（ P〈0. 05）. Conclusion The degree of sleep disorders gradually increases with age increasing in untreated middle aged OSAHS patients. The progress trend of sleep disorders in untreated elderly OSAHS patients slows down with prolonged course of sleep disorders,but the cardiovascular and cerebrovascular and other complications obviously increased.