喉部或下咽部恶性肿瘤患者发生阻塞性睡眠呼吸暂停综合征的影响因素研究

Study on Influence Factors of Obstructive Sleep Apnea Syndrome in Patients with Laryngeal or Hypopharyngeal Cancer

目的探讨喉部或下咽部恶性肿瘤患者发生阻塞性睡眠呼吸暂停综合征(OSAS)的影响因素,为防止肿瘤进一步生长、降低手术风险及术后并发症、提高患者的生活质量提供帮助。方法选取2016年2—9月于郑州大学第一附属医院耳鼻咽喉头颈外科就诊的符合纳入标准的喉部或下咽部恶性肿瘤患者50例,并收集患者的临床资料。采用便携式睡眠监测仪监测患者睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度等数据;其中AHI≥5次/h即可诊断为OSAS。根据患者是否发生OSAS,将其分为OSAS组和非OSAS组,比较两组性别、年龄、体质指数(BMI)、肿瘤部位、肿瘤分期。并采用多因素Logistic回归分析分析喉部或下咽部恶性肿瘤患者发生OSAS的影响因素。结果50例患者中男性较多,占94%;平均年龄(63.9±9.9)岁;平均BMI(22.5±3.0)kg/m^2;肿瘤部位:声门上型13例(26%),声门型25例(50%),下咽12例(24%);肿瘤分期:T_1期20例(40%),T_2期15例(30%),T_3期6例(12%),T_4期9例(18%);平均AHI(15.8±11.9)次/h;平均最低血氧饱和度72.8%±10.8%。50例患者中AHI≥5次/h 43例,即OSAS组43例,非OSAS组7例。OSAS组患者年龄大于非OSAS组患者(P<0.05)。多因素Logistic回归分析结果显示,年龄是喉部或下咽部恶性肿瘤患者发生OSAS的危险因素[OR=1.133,95%CI(1.023,1.255),P=0.016]。结论喉部或下咽部恶性肿瘤患者OSAS发生率较高,且年龄是其发生OSAS的危险因素,而BMI、肿瘤部位、肿瘤分期与OSAS的发生无明显关系。

Objective To investigate the influence factors of the occurrence of obstructive sleep apnea syndrome（ OSAS） in patients with laryngeal or hypopharyngeal cancer,in order to help prevent tumor growth,reduce the risk of surgery and postoperative complications and improve the quality of life of these patients. Methods Fifty patients with laryngeal or hypopharyngeal cancer who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Zhengzhou University and met the inclusion criteria were selected from February to September in 2016. The clinical information of these patients were collected. All patients underwent portable monitor device. The sleep apnea hypopnea index（ AHI）,the minimum oxygen saturation and other data were monitored by portable sleep monitor. OSAS was diagnosed when AHI value was ≥5 times/h. The patients were divided into OSAS and non-OSAS groups according to whether the patient developed OSAS. The sex,age,body mass index（ BMI）,tumor location and tumor stage were compared between the two groups. And multivariate Logistic regression analysis was used to analyze the influencing factors of the occurrence of OSAS in patients with laryngeal or hypopharyngeal cancer. Results There were more males in the 50 patients,accounting for 94%. The mean age was（ 63. 9 ± 9. 9） years and the mean BMI was（ 22. 5 ± 3. 0） kg/m^2. The tumor location： supraglottic carcinoma in 13 cases（ 26%）,glottic laryngeal carcinoma in 25 cases（ 50%） and hypopharyngeal carcinoma in 12 cases（ 24%）. The tumor stage：T_1 in 20 cases（ 40%）,T_2 in 15 cases（ 30%）,T_3 in 6 cases（ 12%） and T_4 in 9 cases（ 18%）. The mean AHI was（ 15. 8± 11. 9） times/h,the mean minimum oxygen saturation was 72. 8% ± 10. 8%. In 50 patients,there were 43 cases with AHI value ≥5 times/h,that was 43 patients in OSAS group and 7 patients in non-OSAS group. The age of patients in OSAS group was greater than that in non-OSAS group（ P〈0.05）. Multivariate Logistic regression analysis showed that age was a risk factor of the occurrence of OSAS in patients with laryngeal or hypopharyngeal cancer [OR = 1. 133,95% CI（ 1. 023,1. 255）,P= 0. 016]. Conclusion The incidence of OSAS is higher in patients with laryngeal or hypopharyngeal cancer. And age is a risk factor of OSAS,while BMI,tumor location and tumor stage are not related to the occurrence of OSAS.