阻塞性睡眠呼吸暂停低通气综合征患者睡眠参数与白天嗜睡、睡眠质量及体质量指数的相关性研究

The correlations between sleep monitoring indicators and sleep quality or drowsiness or body mass index in OSAHS patients

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠监测指标与白天嗜睡、睡眠质量、体质量指数(BMI)的相关性。方法选取2020年4月至2021年2月以睡眠打鼾、呼吸暂停为主要症状就诊于苏北人民医院耳鼻咽喉头颈外科318例患者作为研究对象,分别进行Epworth嗜睡量表(Epworth sleeping scale,ESS)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分和多道睡眠图(PSG)监测,整理数据后筛选出符合要求者216例。根据睡眠监测结果将研究对象分为对照组25例(AHI<5次/h)、轻度OSAHS组52例(5次/h≤AHI<15次/h)、中度OSAHS组48例(15次/h≤AHI<30次/h)、重度OSAHS组91例(AHI≥30次/h)。比较各组PSG相关指标、ESS总分、PSQI总分及BMI,利用Pearson相关分析,探讨ESS总分、PSQI总分、BMI与PSG指标相关性。结果①各组体位改变次数、俯卧位呼吸暂停低通气次数差异无统计学意义,其余各项PSG研究指标差异均有统计学意义(P<0.05);②四组受试者ESS总分和BMI差异有统计学意义,PSQI总分差异无统计学意义;③AHI、ODI、体位改变次数与ESS总分呈正相关(r=0.272、0.287、0.141,P<0.01),平均血氧饱和度(average oxygen saturation,ASaO_(2))、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))与ESS总分呈负相关(r=-0.333、-0.299,P<0.01),平均心率(average heart rate,AHR)与ESS总分无显著相关性(r=0.009,P=0.894);AHI、ODI与BMI呈正相关(r=0.317、0.363,P<0.01),ASaO_(2)、LSaO_(2)与BMI呈负相关(r=-0.273、-0.271,P<0.01),体位改变次数、AHR与BMI无显著相关性(r=0.055、0.038,P=0.422、0.574);PSQI总分与所研究的PSG指标无显著相关性。结论ESS和BMI均能在各自层面反映OSAHS严重程度。AHI、ODI越高,LSaO_(2)、ASaO_(2)越低,则ESS总分越高,BMI越大,OSAHS越严重;夜间体位改变次数越多,ESS总分越高,患者白天嗜睡越严重。虽然PSQI总分与PSG监测指标无明显相关性,但可反映OSAHS患者的精神和心理状态,大部分患者带有抑郁或焦虑情绪,造成OSAHS患者不良预后。三者联合可作为OSAHS的初筛,评估其严重程度,为早期干预、改善预后提供依据。

Objective To explore the correlations between sleep monitoring indicators and sleep quality or drowsiness or body mass index in OSAHS patients.Methods 318 patients with sleep snoring and apnea from April 2020 to February 2021 were selected as subjects in Northern Jiangsu People's Hospital.They were evaluated by Epworth sleeping scale(ESS),Pittsburgh sleep quality index(PSQI)and polysomnography(PSG),216 patients were reserved after sorting the data.According to the results of PSG,it was divided into control group of 25 cases(AHI<5 times/h),mild OSAHS group of 52 cases(5 times/h≤AHI<15 times/h),moderate OSAHS group of 48 cases(15 times/h≤AHI<30 times/h),and severe OSAHS group of 91 cases(AHI≥30 times/h).The PSG-related index,BMI and the score of ESS and PSQI were compared in each group.Results 1.There were no significant differences in the number of postural changes and the number of apnea hypopnea in prone position,while other PSG indexes had statistical significances(P<0.05).2.The differences of ESS total scores and BMI among the four groups were statistically significant,the differences of PSQI total scores were not statistically significant.3.AHI,ODI and the number of postural changes were positively correlated with ESS total scores(r=0.272,0.287,0.141,P<0.01),ASaO_(2) and LSaO_(2) were negatively correlated with it(r=-0.333,-0.299,P<0.01),there was no significant difference between average heart rate and ESS total scores.AHI and ODI were positively correlated with BMI total scores(r=0.317,0.363,P<0.01),ASaO_(2) and LSaO_(2) were negatively correlated with it(r=-0.273,-0.271,P<0.01),there was no significant correlation among the number of postural changes,average heart rate and BMI.There was no significant correlation between PSQI total scores and the PSG indexes studied.Conclusions ESS and BMI can reflect the severity of OSAHS in their level.The higher AHI,ODI and the lower LSaO_(2),ASaO_(2) there are,the higher ESS total scores and BMI will be,which leads to more severe OSAHS.The more times the postural change occurs at night,the higher score the ESS will be,which leads to more severe drowsiness.While PSQI total scores have no significant correlation with PSG monitoring indicators,it can reflect mental and psychological state of OSAHS patients.Most patients have depression or anxiety,which can cause poor prognosis in OSAHS patients.The combination of the three can be used as a OSAHS screening.They can evaluate severity and provide basis for early intervention in OSAHS patients.