中重度OSAHS患者日间过度嗜睡的影响因素研究

Factors related to excessive daytime sleepiness in patients with moderate to severe obstructive sleep apnea/hypopnea syndrome

目的通过分析多导睡眠监测(PSG)相关参数,探讨中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者日间过度嗜睡(EDS)的可能影响因素。方法应用Epworth嗜睡量表(ESS)评估272例中重度OSAHS患者的EDS,根据ESS将患者分为有EDS组(ESS>10)和无EDS组(ESS≤10),比较两组夜间低氧和睡眠结构相关参数的差异。结果 EDS组95例,无EDS组177例,两组ESS分别为14±3和6±3。两组呼吸暂停低通气指数(AHI)差异无统计学意义(58.0±21.0 vs 54.7±17.7,P>0.05);EDS组夜间最低血氧饱和度较无EDS组更低[(63.1±15.8)%vs(67.5±14.0)%,P<0.05],夜间氧饱和度<90%的时间占睡眠时间的百分比(SIT90)较无EDS组更高[(39.3±30.5)%vs(28.2±25.3)%,P<0.05]。多因素分析显示SIT90是OSAHS患者EDS的独立影响因素。两组间夜间平均血氧饱和度、氧减指数(ODI)和睡眠结构相关参数差异均无统计学意义(均P>0.05)。结论有EDS的中重度OSAHS患者较无EDS的患者夜间低氧程度更重,且夜间低氧是中重度OSAHS患者EDS的独立危险因素。

Objective To investigate the factors related to excessive daytime sleepiness(ESS) in patients with moderate to severe obstructive sleep apnea/hypopnea syndrome(OSAHS). Methods Daytime sleepiness was evaluated by Epworth sleepiness scale(ESS) in 272 patients with moderately to severe OSAHS. According to ESS scores, there were 95 patients with EDS(ESS >10) and177 patients without EDS(ESS ≤10). All patients underwent polysomnography(PSG) examination, and parameters related to nocturnal hypoxia and sleep architecture were compared between the two groups. Results The ESS of patients with or without EDS were 14±3and 6±3, respectively. Both groups exhibited a similar apnea/hypopnea index(58.0 ±21.0 vs 54.7 ±17.7). Patients with EDS exhibited lower minimal nocturnal SpO2 [(63.1±15.8)% vs(67.5±14.0)%]and longer time with SpO2 below 90% [(39.3±30.5)% vs(28.2±25.3)%] than those without EDS. Multivariate analysis revealed that SIT90 was an independent determinant of EDS. Mean nocturnal SpO2,oxygen desaturation index and sleep architecture did not differ between the groups. Conclusion Moderate to severe OSAHS patients with EDS exhibit higher SIT90 than those without EDS. Nocturnal hypoxia may be a determinant of EDS in OSAHS patients.