体位改变对OSAHS患者过度日间嗜睡的影响及相关性分析

Effects of sleep body posture on subjective sleepiness in patients with OSAHS

目的:研究体位改变对OSAHS患者日间嗜睡的影响及相关性分析。方法:对90例OSAHS患者行Epworth嗜睡量表嗜睡量表评分(ESS)并按呼吸暂停低通气指数(AHI)分为轻度OSAHS组(5≤AHI<15)、中度OSAHS组(15≤AHI<30)和重度OSAHS组(AHI≥30),比较体位改变对不同程度OSAHS患者日间嗜睡的影响。结果:由仰卧位变换为侧卧位时,3组微觉醒指数差异、夜间最低血氧饱和度(MinSpO2)、REM睡眠占总睡眠时间的百分率(REM%)及NREM睡眠占总睡眠时间的百分率(NREM%)均差异有统计学意义(F=12.10、43.67、15.81、13.17,均P<0.05);与仰卧位相比,OSAHS重度组侧卧位时MinSpO2、REM%及NREM%差异有统计学意义(t=3.02、2.41、2.90,均P<0.05)。仰卧位呼吸暂停指数(S-AHI)、侧卧位呼吸暂停指数(LAHI)与OSAHS轻、中度组ESS评分无相关性(P>0.05),而L-AHI与OSAHS重度组ESS评分显著相关(r=0.454,P<0.01);REM L-AHI和NREM L-AHI与OSAHS重度组ESS评分显著相关(r=0.522,P<0.01;r=0.425,P<0.001)。结论:睡眠体位改变对重度OSAHS组的睡眠结构、呼吸事件有显著的影响,与S-AHI相比,L-AHI更能反映重度OSAHS患者日间嗜睡严重程度。

Objective：To observe the effects of sleep body posture on subjective sleepiness in patients with OSAHS.Method：We assessed the sleeping body position,the sleep structure,position specific AHI and the Epworth Sleepiness Scale（ESS）in a total of 90 patients with OSAHS.The patients were grouped according to AHI：mild OSAHS（5≤AHI15）,moderate（15≤AHI30）and severe（AHI≥30）.The polysomnography data and clinical characteristics were compared between each group.Result：There was statistically significant difference in arousal index,MinSpO2,REM% and NREM% among three groups（Fvalue was 12.10,43.67,15.81,13.17,respectively,P〈0.05）.Compared with supine,the severe OSAHS group had significantly bigger changes in MinSpO2,REM% and NREM%（t value was 3.02,2.41,2.90,respectively,P〈0.05）.For mild-to-moderate groups,there was no correlation between the ESS and the AHI at any position（P〉0.05）.For severe group,the ESS was significantly correlated with L-AHI（r=0.454,P〈0.01）;the REM L-AHI and NREM L-AHI was also significantly correlated with ESS of severe group（r=0.522 and 0.425,P〈0.01）.Conclusion：The sleep body posture had significant effects on sleep structure and respiratory events in severe OSAHS group.The L-AHI was found to have a closer association with daytime sleepiness in severe OSAHS than other groups.