不同严重程度阻塞性睡眠呼吸暂停与睡眠结构的关系

Relationship between sleep architecture and severity of obstructive sleep apnea

目的:研究阻塞性睡眠呼吸暂停(OSA)对各期睡眠的影响,并分析非快速眼动Ⅲ期(N3期)睡眠与呼吸异常事件的关系。方法:对2019年6月24日至12月26日在浙江大学医学院附属邵逸夫医院睡眠中心接受整夜多导睡眠图监测的188例成年患者进行回顾性分析。OSA患者的严重程度根据呼吸暂停低通气指数(AHI)进行分类,比较各期睡眠中的多导睡眠图监测各项指标,以及在各期睡眠中的AHI与最低血氧饱和度。结果:不同严重程度OSA患者的总睡眠时间与睡眠效率相差不大(均P>0.05)。与轻度OSA组比较,中度OSA组和重度OSA组N3期睡眠占比更小(均P<0.05);与中度OSA组比较,重度OSA组N3期睡眠占比更小(P<0.05)。与轻度OSA组比较,中度OSA组和重度OSA组N3期潜伏期更长(均P<0.05);与中度OSA组比较,重度OSA组N3期潜伏期更长(P<0.05)。不同严重程度OSA患者AHI存在差异。与N1、N2、快速眼动期比较,不同严重程度OSA组N3期AHI比N1、N2、快速眼动期更小(均P<0.01)。仰卧位时,轻度和中度OSA组N3期AHI比N1、N2、快速眼动期更小(均P<0.01),重度OSA组的N3期AHI比N2、快速眼动期也更小(P<0.05或P<0.01)。与N1、N2、快速眼动期比较,不同严重程度OSA患者N3期最低血氧饱和度更高(P<0.05或P<0.01)。结论:OSA患者的N3期睡眠减少,且患者在N3期呼吸异常事件的发生率更低,提示通过增加OSA患者的N3期睡眠比例可能可以改善OSA。

Objective:To investigate the effect of obstructive sleep apnea(OSA)on different sleep stages,and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events.Methods:A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study.OSA patients were classified into 3 groups(mild,moderate and severe)according to the apnea-hypopnea index(AHI).PSG data,AHI and the lowest SPO 2 in each stage of sleep were compared among three groups.Results:There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA(all P>0.05).The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group(all P<0.05).The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group(P<0.05).In addition,severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups(all P<0.05).The latency of N3 stage in moderate OSA group was longer than that in mild OSA group(P<0.05).The AHI in N3 stage was markedly lower than that in other sleep stages(all P<0.01),regardless of the severity of OSA.Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1,N2 and rapid eye movement(REM)stages(all P<0.01).Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages(P<0.05 or P<0.01).The lowest SPO 2 in N3 stage was significantly higher than that in N1,N2 and REM stages(P<0.05 or P<0.01),regardless of the severity of OSA.Conclusions:The proportion of N3 stage is lower in OSA patients,and N3 stage has less sleep respiratory events than non-N3 stages.The results suggest that the increased N3 stage proportion may indicate less severity of OSA.