阻塞性睡眠呼吸暂停低通气综合征的呼吸阻力变化的意义

Alterations of respiratory resistance in patients with obstructive sleep apnea hypopnea syndrome

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸阻力各成分的变化,分析其与OSAHS程度相关性。方法收集2015年1月~2017年9月南方医科大学南方医院呼吸睡眠中心初诊的睡眠打鼾患者,共234例。所有患者记录人体学特征与睡眠监测、肺功能、脉冲震荡技术呼吸阻力检查结果,根据呼吸暂停低通气指数(AHI)将其分为非OSAHS组(AHI<5)、轻中度(AHI,5-30)及重度OSAHS(AHI>30)组,比较各组间呼吸阻力不同成分的差异,并分析各成分与AHI的相关性。结果 234例患者中非OSAHS组31例,轻中OSAHS组90例,重度OSAHS组113例。5 Hz时气道阻抗值(R5)、20 Hz时气道阻抗值(R20)、50%用力呼气流速(FEF50%)、中段用力呼气流速(MMEF)在重度OSHAS组与非OSAHS组间比较差异有统计学意义(P<0.05)。双变量相关分析示,R5、R20、FEF50%均与AHI呈正相关(r=0.259,P=0.000;r=0.298,P=0.000;r=0.176,P=0.007)。结论OSAHS大气道基础阻力升高,而小气道阻力代偿性下降。

Objective To evaluate the association between the components of airway resistance and severity of obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods A total of 234 patients with snoring during sleep underwent full-night polysomnography in our center between January, 2015 and September, 2017. According to the apnea-hypopnea index（AHI）scores, the patients were divided into non-OSAHS group（AHI scores 5）, mild or moderate OSAHS group（5-30） group, and severe OSAHS group（30）. The pulmonary function and respiratory resistance of the patients were assessed using spirometry and impulse oscillometry, respectively, and the correlation between the parameters of respiratory resistance and the severity of AHI were analyzed. Results The non-OSAHS, mild or moderate OSAHS, and severe OSAHS groups consisted of 31, 90 and113 patients, respectively. The patients with severe OSAHS had significantly higher levels of respiratory resistance at 5 Hz（R5）and 20 Hz（R20）, FEF50%and MMEF than those in the other two groups（P〈0.05）. Bivariate correlation analysis identified positive correlations of R5（r=0.259, P=0.000）, R20（r=0.298, P=0.000） and FEF50%（r=0.176, P=0.007） with AHI scores of the patients. Conclusion Patients with OSAHS have increased respiratory resistance in the large airways and compensatory reduction in small airway resistance.