阻塞性睡眠呼吸暂停低通气综合征患者自动正压通气治疗压力值的影响因素分析

The Determinants of Therapeutic Levels of Continuous Positive Airway Pressure Level in Patients With Obstructive Sleep Apnea

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者自动正压通气(Auto-PAP)治疗压力值的相关影响因素,归纳压力预测值的回归函数。方法:选取于我院通过多导睡眠监测(PSG)符合OSAHS诊断并行自动压力滴定治疗的患者101例,回归性分析患者Auto-PAP滴定的90%治疗压力值(P90)与年龄、体重指数、颈腰围、血压以及呼吸暂停指数(AHI)等PSG指标以及压力滴定治疗后残余AHI等的关系。结果:P90与体重指数、颈围、收缩压、AHI、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)、血氧饱和度小于90%时间占总睡眠时间百分比(SLT90%)存在线性回归关系(相关系数分别为0.206、0.239、0.224、0.256、-0.352、-0.263、0.027,P均<0.05)。选取上述指标与P90进行多元线性逐步回归分析,得出可纳入回归方程的指标有MSaO2、收缩压两项(标准化回归系数分别为-0.331、-0.187;P值分别为0.001、0.047)。最终得出的P90预测值函数方程为:P90=20.703+0.022×收缩压-0.144×MSaO2。结论:OSAHS患者P90与肥胖程度、呼吸暂停、缺氧程度、患者血压等多因素相关,其P90预测值函数方程为:P90=20.703+0.022×收缩压-0.144×MSaO2。

Objectives:To explore the related factors affecting the therapeutic levels of automatic positive airway pressure(Auto-PAP)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and to obtain the regression function of pressure prediction value.Methods:A total of 101 OSAHS patients,who were diagnosed by polysomnographic(PSG)and received the treatment of automatic pressure titration,were included in this study.Regression analysis was performed to define the relationship between the 90%treatment pressure value(P90)and PSG indicators such as apnea index(AHI),residual AHI after treatment,body mass index(BMI),neck and waist circumference,and blood pressure.Results:The P90 was significantly correlated with the BMI,neck circumference,systolic blood pressure(SBP),AHI,the average saturation of blood oxygen during nighttime(MSaO2),lowest oxygen saturation(LSaO2),and the saturation less than 90%of total sleep time(SLT90%).The correlation coefficients were 0.206,0.239,0.224,0.256,-0.352,-0.263 and 0.027,respectively(all P<0.05).Multiple linear stepwise regression analysis showed that MSaO2 and SBP could be included in the regression equation(the standardized regression coefficients were-0.331,-0.187;P=0.001 and 0.047,respectively).The function equation of P90 predicted value is:P90=20.703+0.022×SBP-0.144×MSaO2.Conclusions:The P90 value in OSAHS patients is correlated with obesity,apnea,hypoxia and blood pressure.The function equation of P90 predicted value is:P90=20.703+0.022×SBP-0.144×MSaO2.