可调式阻鼾器改善OSAS患者脑部供氧和慢性脑供血不足的临床研究

An adjustable anti-snoring device improves brain oxygen supply and chronic cerebral circulation insufficiency in patients with obstructive sleep apnea syndrome

目的探讨可调式阻鼾器改善阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome,OSAS)患者脑部供氧和慢性脑供血不足的效果。方法选择惠东县人民医院2018年1-9月就诊的OSAS患者34例为OSAS组,同期在该医院体检性别和年龄匹配的健康志愿者34例为对照组。通过多导睡眠图测量呼吸暂停低通气指数(AHI)评分;通过经颅多普勒超声测量脑血流速度;通过静脉闭塞体积描记法测量前臂血流量;通过心电图获得心率;通过脉搏血氧测定法获得动脉血氧饱和度(SaO_(2));通过自动血压计获得血压;检测OSAS患者外周和脑血流动力学;使用多导睡眠仪检测患者的夜间睡眠质量情况;用头颅定位X线摄影机摄取头颅侧位片用于矫正测量结果。结果OSAS组性别和年龄与对照组比较,差异均无统计学意义(均P>0.05)。OSAS组体质量指数、AHI和SaO_(2)低于90%的时间百分比均高于对照组,并且最小SaO_(2)更低,差异均有统计学意义(均P<0.05);OSAS组的心率[(76.27±9.34)次/min]和前臂血流量[(7.24±3.13)mL·100 mL^(-1)·min^(-1)]均高于对照组[(65.42±6.38)次/min、(4.11±1.25)mL·100 mL^(-1)·min^(-1)],而阻鼾器治疗能够降低OSA组患者心率[(66.17±4.53)次/min]和前臂血流量[(4.54±3.26)mL·100 mL^(-1)·min^(-1)]差异均有统计学意义(F=2.66、0.85,均P<0.05);OSAS组脉搏血氧饱和度(SpO_(2))、组织血氧饱和度(StO_(2))和总血红蛋白较对照组明显降低,阻鼾器治疗组较OSAS组明显升高,差异均有统计学意义(F=12.33、13.57、14.22,均P<0.05);阻鼾器治疗组的打鼾数和睡眠惊醒数明显降低,差异均有统计学意义(χ^(2)=13.14、12.36,均P<0.05);在腭咽径、舌咽径、喉咽径的检测上,阻鼾器治疗组较OSAS组数据明显上升,阻鼾器治疗组数据几乎接近健康人标准,治疗效果明显,差异均有统计学意义(t=11.46、15.13、12.58,均P<0.05)。结论可调式阻鼾器能够改善OSAS患者脑部供氧与慢性脑供血不足,治疗轻度/中度OSAS的效果显著。

Objective To investigate the efficacy of an adjustable anti-snoring device in improving brain oxygen supply and chronic cerebral circulation insufficiency in patients with obstructive sleep apnea syndrome(OSAS).Methods Thirty-four patients with OSAS who received treatment in Huidong People's Hospital from January to September 2018 were included in the OSAS group.An additional 34 sex-and age-matched healthy volunteers who concurrently received physical examination were included in the control group.Apnea-hypopnea index score for each patient was determined by polysomnography.Cerebral blood flow velocity was measured by transcranial Doppler ultrasonography.Forearm blood flow was measured by venous occlusion plethysmography.Heart rate was obtained by electrocardiography.Arterial oxygen saturation(SaO_(2))was obtained using pulse oximetry.Blood pressure was obtained by an automatic sphygmomanometer.Peripheral and cerebral hemodynamics of patients with OSAS were measured.Nighttime sleep quality of patients was assessed using polysomnography.Lateral projection of the skull was photographed using an X-ray machine for correcting measurement results.Results There were no significant differences in sex and age between OSAS and control groups(both P>0.05).Body mass index,Apnea-hypopnea index score and the percentage of time spent at SaO_(2) below 90%in the OSAS group were significantly higher than those in the control group(all P<0.05).The lowest SaO_(2) value in the OSAS group was significantly lower than that in the control group(P<0.05).Heart rate and forearm blood flow in the OSAS group were(76.27±9.34)beats/min and(7.24±3.13)mL·100 mL^(-1)·min^(-1),respectively,which were significantly higher than those in the control group[(65.42±6.38)beats/min,(4.11±1.25)mL·100 mL^(-1)·min^(-1)].After treatment with an adjustable anti-snoring device,heart rate and forearm blood flow in the OSAS group were(66.17±4.53)beats/min and(4.54±3.26)mL·100 mL^(-1)·min^(-1),respectively,which were significantly lower than those in the control group(F=2.66,0.85,both P<0.05).Peripheral oxygen saturation,tissue oxygen saturation,and total hemoglobin in the OSAS group were significantly lower than those in the control group.These indexes in the anti-snoring device treatment group were significantly higher than those in the OSAS group(F=12.33,13.57,14.22,all P<0.05).The number of snorings and number of wake-ups from sleep in the anti-snoring device treatment group were significantly lower compared with those in the OSAS group(χ^(2)=13.14,12.36,both P<0.05).Palatopharyngeal diameter,glossopharyngeal diameter and laryngopharyngeal diameter in the anti-snoring device treatment group were significantly higher than those in the OSAS group,and they were almost close to the levels of healthy people(t=11.46,15.13,12.58,all P<0.05).Conclusion Adjustable anti-snoring device can improve brain oxygen supply and chronic cerebral circulation insufficiency in patients with OSAS,in particular with mild and moderate OSAS.