快速动眼睡眠型和非快速动眼睡眠型阻塞性睡眠呼吸暂停综合征患者的临床特征分析

Analysis of clinical features between rapid eye movement and non-rapid eye movement related obstructive sleep apnea

目的比较快速动眼睡眠(REM)型和非REM(NREM)型阻塞性睡眠呼吸暂停综合征(OSA)患者的临床特征、多导睡眠监测(PSG)参数和血清学指标间的差异。方法收集2018年1月至2019年6月住院且PSG提示总呼吸暂停低通气指数(AHI)≥5的OSA患者129例。统计REM期AHI值(AHI_(REM))和NREM期AHI值(AHI_(NREM))。依据Oksenberg分型,将AHI_(REM)/AHI_(NREM)≥2分为REM-OSA组,AHI_(REM)/AHI_(NREM)﹤2分为NREM-OSA组。观察指标包括患者性别、年龄、体重指数(BMI)、首诊符合率、Epworth嗜睡量表(ESS)、匹兹堡睡眠质量指数(PSQI)、抑郁自评量表(SDS)和焦虑自评量表(SAS)、PSG参数、血清超敏C反应蛋白、IL-6及二氧化碳结合率等。结果两组患者在性别、年龄、BMI、首诊符合率、SAS分值、AHI_(NREM)、总AHI值、最低动脉血氧饱和度(L-SaO_(2))、血氧饱和度低于90%持续时间百分比(CT90)、血清超敏C反应蛋白和二氧化碳结合率的差异具有统计学意义(均P<0.05)。相关性分析显示,OSA患者L-SaO_(2)与BMI、PSQI分值、总睡眠时间、睡眠效率、NREM 2期所占睡眠总时间百分比、总AHI值、AHI_(NREM)、AHI_(REM)、AHI_(REM)/AHI_(NREM)比值、血清超敏C反应蛋白分别存在负相关性(均P<0.05);OSA患者总AHI值与BMI、睡眠效率、AHI_(NREM)、AHI_(REM)、血清超敏C反应蛋白分别存在正相关性(均P<0.05),而与性别、AHI_(REM)/AHI_(NREM)比值分别存在负相关性(均P<0.05)。结论与NREM-OSA相比,REM-OSA患者年龄偏低,女性占比较高,体重偏轻,L-SaO_(2)更低,CT90更大,同时REM-OSA患者超敏C反应蛋白水平和血清二氧化碳结合率较高。两组最低氧减皆发生在REM睡眠期,与睡眠质量存在相关性。因此REM-OSA并不是单纯数学意义上的分型,它更可能是被忽视的诊断,积极的早期识别和处理可能为患者带来获益。

Objective To compare differences in clinical features,polysomnographic(PSG)features and serum marker between rapid eye movement(REM)related obstructive sleep apnoea(OSA)and non-REM(NREM)related OSA patients.Methods Total 129 patients with a diagnosis of OSA who had apnea hypopnea index(AHI)≥5 during January 2018 to June 2019 were involved.The AHI of REM(AHI_(REM))and the AHI of NREM(AHI_(NREM))were calculated.According to Oksenberg classification,patients with AHI_(REM)/AHI_(NREM)≥2 were classified as REM-OSA group,and patients with AHI_(REM)/AHI_(NREM)<2 were classified as NREM-OSA group.The parameters including sex,age,body mass index(BMI),first visit compliance rate,Epworth sleepiness scale(ESS),Pittsburgh sleep quality index(PSQI),self-rating depression scale(SDS),self-rating anxiety scale(SAS),PSG,hypersensitive C-reactive protein,IL-6 and carbon dioxide binding rate,et al.Results There were significant differences in sex,age,BMI,first visit compliance rate,SAS scores,AHI_(NREM),total AHI,lowest blood oxygen saturation(L-SaO_(2)),cumulative percentage of time spent at saturation below 90%(CT90),serum high sensitivity C-reactive protein and carbon dioxide binding rate between the two groups(all P<0.05).The correlation analysis shows that,there were negative correlations between L-SaO_(2)and BMI,PSQI score,total sleep time,sleep efficiency,percentage of total sleep time in NREM 2,total AHI,AHI_(NREM),AHI_(REM),AHI_(REM)/AHI_(NREM)ratio,serum high sensitivity C-reactive protein in OSA patients(all P<0.05).There were positive correlations between total AHI and BMI,sleep efficiency,AHI_(NREM),AHI_(REM)and serum high sensitivity C-reactive protein in OSA patients(all P<0.05).There were negative correlations between total AHI and sex,AHI_(REM)/AHI_(NREM)ratio in OSA patients(all P<0.05).Conclusions This study demonstrates that in comparison with NREM-OSA,REM-OSA occurs more commonly in women and younger individuals who even not fat.REM-OSA is more serious than NREM-OSA,which the L-SaO_(2)is lower,CT90 is higher and the serum carbon dioxide binding rate and the level of hypersensitive C-reactive protein are increased.The lowest oxygen reduction occurres in REM sleep stage and correlated with sleep quality in both groups.So REM-OSA is not only a simple classifications in the sense of numbers,but more likely to be a neglected diagnosis.Active early recognition and treatment may bring benefits to patients.