持续气道正压通气对阻塞性睡眠呼吸暂停患者睡眠周期性肢体运动的影响

Effects of continuous positive airway pressure on periodic limb movements during sleep in patients with obstructive sleep apnea

目的探讨持续气道正压通气（CPAP）对阻塞性睡眠呼吸暂停（OSA）患者睡眠周期性肢体运动（PLMS）的影响。方法回顾性分析2015年1月至2017年1月因打鼾在四川大学华西医院睡眠医学中心就诊、经多导睡眠监测（PSG）确诊为OSA且接受CPAP治疗的828例患者的临床资料。患者CPAP治疗均采取人工滴定方式进行。根据基线及CPAP治疗时PLMS指数（PLMI）及其变化（界值：PLMI≥15次／h），将患者分为4组：持续组、新发组、消失组和无PLMS组。结果828例患者中男756例（91．3％），女72例（8．7％）；年龄（45．7±10．7）岁；体质指数（BMI）（27．6±3．5）kg/m2；其中持续组、新发组、消失组和无PLMS组分别占32例（3．9％）、85例（10．3％）、62例（7．5％）和649例（78．4％）。女性与持续组显著相关（P=0．004）；年龄≥45岁、基线呼吸暂停低通气指数（AHI）≥30次／h与新发组显著相关（P=0．012、0．030）。年龄≥45岁与无PLMS组负相关（P=0．006）。结论基线时AHI较高的老年患者更容易在CPAP治疗时新发PLMS。

Objective To investigate the effects of continuous positive airway pressure （CPAP） on periodic limb movements during sleep （PLMS） in patients with obstructive sleep apnea （OSA）. Methods The polysomnography （PSG） data of 828 consecutive OSA outpatients from January 2015 to January 2017 who had undergone overnight CPAP titration were analyzed retrospectively. On the basis of changes in periodic limb movements index （PLMI） values （cut off level≥ 15/h） from baseline PSG （BPSG） to CPAP titration PSG, patients were assigned to one of the following four groups ： persistent, CPAP-emergent, CPAP- disappeared, and non-PLMS. Results Among 828 patients, 756 （91.3%） were male and 72 （8.7%） were female. The mean age was （45. 7 ± 10. 7） years old, the mean body mass index （BMI） was （27. 6 ± 3.5） kg/m2. The rate of patients was 3.9% in the persistent group, 10. 3% in the CPAP-emergent group, 7.5% in the CPAP-disappearance group, and 78.4% in the non-PLMS group. Multivariate Logistic regression analysis revealed that female appeared to be associated with the persistent group （ P = 0. 004 ） ; older age and higher apnea-hypopnea index （ AHI ） on BPSG appeared to be associated with the CPAP- emergent group （P =0. 012, 0. 030）. On the other hand, older age was negatively associated with the non- PLMS group （ P = 0. 006）. Conclusion Elderly patients with higher AHI at BPSG may present with CPAP- emergent PLMS.