尿毒症患者睡眠呼吸暂停低通气综合征的发病情况研究

Study on sleep apnea-hypopnea syndrome in patients with uraemia

目的调查尿毒症患者中睡眠呼吸暂停低通气综合征(sleep apnea-hypopnea syndrome,SAHS)的发病情况,探讨日间常规血液透析(conventional hemodilysis,CHD)治疗对SAHS病情的影响。方法对2013年7月至2014年5月收治的65例尿毒症患者进行睡眠问卷调查及多导睡眠监测(polysomnography,PSG),对部分尿毒症合并SAHS并坚持CHD治疗的患者在透析前夜及透析日当晚分别进行PSG,并比较透析前后患者的呼吸暂停/低通气指数(apnea-hypopnea index,AHI)、阻塞性呼吸暂停指数、中枢性呼吸暂停指数、夜间最低指脉氧饱和度(LSaO 2)、SaO 2<90%总时间及最长氧降时间。运用Logistic回归分析尿毒症患者并发心血管疾病的危险因素。结果尿毒症患者合并SAHS的患病率为89.23%(58例/65例);类型以中枢性呼吸暂停低通气综合征(centrol sleep apnea hypopnea syndrome,CSAHS)为主(30例/58例);透析前后患者的AHI、阻塞性呼吸暂停指数、中枢性呼吸暂停指数、LSaO 2及SaO 2低于90%总时间,差异无统计学意义(P>0.05),但透析后患者的最长氧降时间低于透析前,差异有统计学意义(P<0.05);Logistic回归分析显示合并SAHS是尿毒症患者并发心血管疾病(cardiovascular disease,CVD)的危险因子(OR=9.41,95%CI:2.16~41.03,P<0.05)。结论SAHS在尿毒症患者中普遍存在,以CSAHS为主。SAHS作为一个危险因素可增加尿毒症患者的病死率。单纯CHD治疗不能充分改善患者的SAHS病情。

Objective To investigate the incidence of sleep apnea-hypopnea syndrome(SAHS)in patients with uraemia,and to explre the influence of conventional hemodilysis(CHD)on the severity of SAHS.Methods A total of 65 patients with uraemia who were treated in our hospital from July 2013 to May 2014 were enrolled in the study,who underwent sleep questionnaire investigation and polysomnography(PSG),moreover,PSG monitoring was performed in part of patients with uremia complicated by SAHS who were treated by CHD at the dialysis night and the night before.And the AHI,obstructive apnea index,central apnea index,LSaO 2,and the total time and the longest oxygen reduction time in patients with SaO 2 less than 90%were observed.Moreover the risk factors of cardiovascular disease in patient with uremia were analyzed by means of Logistic regression analysis.Results The prevalence of SAHS in patients with uremia was 89.23%(58/65),and centrol sleep apnea hypopnea syndrome(CSAHS)was the main type(30/58).There were no significant differences in the AHI,obstructive apnea index,central apnea index,and the total time in patients with LSaO 2 and SaO 2 less than 90%before CHD and after CHD(P>0.05),however,the longest oxygen reduction time after CHD was significantly lower than that before CHD(P<0.05).Logistic regression analysis showed that combined SAHS was a risk factor which induced cardiovascular disease(CVD)in patients with uraemia(P<0.05).Conclusion SAHS is common in patients with uremia,and the main type is CSAHS.And SAHS as a risk factor can increase the fatality rate of patients with uremia,moreover,simple CHD can not relieve effectively the disease condition of patients with uraenia complicated by SAHS.