阻塞性睡眠呼吸暂停低通气患者外周化学感受器敏感性改变及其危险因素研究

Study on the sensitivity and risk factors of peripheral chemosensors in patients with obstructive sleep apneahypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者外周化学感受器敏感性改变及其危险因素。方法选取2018年7月至2019年2月中国医科大学附属第一医院28例OSAHS患者为观察组,12例健康者为对照组,并通过低氧撤退试验来评估外周化学感受器的敏感性,同时分析影响OSAHS患者外周化学感受器敏感性改变的危险因素。结果观察组睡前外周化学感受器敏感性的均值(21.74±3.20)低于对照组(25.50±2.85),P<0.05;晨起时高于对照组者[(41.09±8.29)vs.(27.63±2.54),P<0.05],对照组睡前与晨起时外周化学感受器敏感性的均值差异无统计学意义;观察组晨起与睡前时外周化学感受器敏感性差值的均值为(86.87±19.694)与对照组(9.43±11.782)比较,差异有统计学意义(P<0.05)。多元回归分析结果示:呼吸暂停低通气指数(AHI)是OSAHS患者晨起外周化学感受敏感性改变的危险因素(P=0.012),体质量指数(BMI)是睡前外周化学感受器敏感性改变的危险因素(P=0.041)。结论OSAHS患者中存在外周化学感受器敏感性的异常,晨起时外周化学感受敏感性升高,其可能与AHI有关,而睡前外周化学感受器敏感性下降,其可能与BMI有关。

Objective To study the sensitivity of peripheral chemosensors in patients with obstructive sleep apnea-hypopnea syndrome and its risk factors.Methods Twenty-eight OSAHS patients from July 2018 to February 2019 were randomly selected as the case group,and 12 healthy persons as the control group.The sensitivity of peripheral chemosensors were analyzed by multivariate linear regression.The risk factors affecting the sensitivity of peripheral chemosensors in OSAHS patients were analyzed.Results The mean sensitivity of peripheral chemosensors in OSAHS patients before sleep(21.74±3.20)(%ΔV.i)was lower than that in healthy controls(25.50 ±2.85)(P<0.05);however, the sensitivity at morning-onset was higher in case group than in cotrol group[(41.09 ± 8.29)vs.(27.63 ± 2.54), P<0.05];the mean difference of sensitivity between befor-sleep and morning-onset in control group had no statistical difference. The mean difference in peripheral chemoreceptor sensitivity between before-sleep and morning-onset in OSAHS patients was(86.87±19.694)(Δ% ΔV.i), and compared with healthy subjects(9.43 ± 11.782),there was a statistically significant difference(P<0.05).Multivariate regression analysis showed that the apnea hypopnea index(AHI)was a risk factor for peripheral chemosensory sensitivity changes in OSAHS patients(P=0.012);body mass index(BMI)is a risk factor for changes in sensitivity of peripheral chemoreceptors in OSAHS patients before bedtime(P=0.041). Conclusion There are peripheral chemoreceptor sensitivity abnormalities in patients with OSAHS,peripheral chemosensors sensitivity increases in the morning,which may be related to apnea hypopnea index,and peripheral chemosensor sensitivity decreases before bedtime,which may be related to body mass index.