睡眠体位及相关因素对中重度阻塞性睡眠呼吸暂停患者日间过度嗜睡程度的影响研究

Effect of sleep position and related factors on day time sleepiness in patients with moderate to severe obstructive sleep apnea

目的 探讨睡眠体位及相关因素对中重度阻塞性睡眠呼吸暂停(OSA)患者日间过度嗜睡(excessive daytime sleepiness,EDS)严重程度的影响。方法 选取2020年10月~2022年9月在临沂市人民医院睡眠中心收治的106例中重度OSA患者,其中男性91例,女性15例,所有患者均行多导睡眠监测(PSG)。根据Epworth嗜睡量表(ESS)评分将其分为三组,非EDS组48例(ESS≤10分),轻中度EDS组34例(10分<ESS<17分)和重度EDS组24例(ESS≥17分)。分别比较三组患者的一般资料、睡眠体位相关参数、PSG参数,并将组间比较差异有意义的指标与ESS评分行相关性分析,二元logistic回归分析影响中重度OSA患者EDS程度的危险因素。结果 一般资料组间比较,体质量指数(BMI)、颈围和高血压方面差异具有统计学意义(F=3.607、7.797、χ2=8.690,P均<0.05)。其中轻中度组的颈围大于非EDS组,重度组的颈围及BMI均大于非EDS组(P均<0.05)。睡眠体位及PSG参数组间比较,仰卧位AHI、非仰卧位AHI、体位依赖性指数、AHI、非快速动眼期呼吸暂停低通气指数(NREM-AHI)、氧饱和度低于90%的百分比(percentage of total sleep time with oxygen saturation below90%,CT90%)、氧减饱和度指数(ODI)和微觉醒指数(micro-arousal index,MAI)差异有统计学意义(F=3.623、7.892、4.699、5.045、4.779、9.746、5.628、4.913,P均<0.05)。其中轻中度组和重度组的仰卧位AHI、非仰卧位AHI、CT90%、ODI、MAI、NREM-AHI、AHI均高于非EDS组(P均<0.05);重度组的体位依赖性指数显著低于非EDS组,且CT90%高于轻中度组(P均<0.05)。三组患者的ESS评分与仰卧位AHI、非仰卧位AHI、CT90%、ODI、MAI、NREM-AHI、AHI、BMI、颈围、高血压等指标均呈正相关关系(r=0.201、0.332、0.421、0.301、0.273、0.292、0.305、0.211、0.389、0.294,P均<0.05),与体位依赖性指数呈负相关关系(r=-0.282,P<0.05)。多因素分析显示:MAI是轻中度EDS组发病的独立危险因素(OR=1.036,P<0.05),颈围是重度EDS组发病的独立危险因素(OR=1.285,P<0.05)。结论 睡眠体位、颈围、高血压、夜间低血氧和微觉醒均是中重度OSA患者EDS发生的影响因素。非仰卧位AHI较仰卧位AHI更能直接反映中重度OSA患者EDS的严重程度,且体位依赖性指数与严重EDS的发生密切相关。

OBJECTIVECTo investigate the effect of sleep position and related factors on the excessive daytime sleepiness(EDS)in patients with moderate to severe obstructive sleep apnea(OSA).METHODS A total of 106 patients(91 males and 15 females)with moderate to severe OSA admitted to the Sleep Center of Linyi People's Hospital from October 2020 to September 2022 were selected,and all patients underwent polysomnography(PSG)monitoring.They were divided into three groups according to the Epworth sleepiness scale(ESS)score,non-EDS group(ESS≤10,n=48),mild-to-moderate EDS group(10<ESS<17,n=34)and severe EDS group(ESS≥17,n=24).The general data,sleep position-related parameters,and PSG parameters of the three groups were compared,and the indicators with significant differences among groups were correlated with ESS scores,and binary logistic regression was used to analyze the risk factors affecting the degree of daytime sleepiness in patients with moderate to severe OSA.RESULTS There were significant differences in body mass index(BMI),neck circumference and hypertension among groups(F-3.607,7.797,x^(2)=8.690,all P<0.05).Of this,the neck circumference of the mild to moderate EDS group was greater than that of the non-EDS group,and the neck circumference and BMI of the severe EDS group were greater than those of the non-EDS group(all P<0.05).There were significant differences in supine AHI,non-supine AHI,postural dependence index,AHI,non-rapid eye movement apnea-hypopnea index(NREM-AHI),percentage of oxygen saturation less than 90%(CT90%),oxygen desaturation index(ODI)and micro-arousal index(MAI)between sleep position-related parameters and PSG parameters(F=3.623,7.892,4.699,5.045,4.779,9.746,5.628,4.913,P<0.05).The supine AHI,non-supine AHI,CT90%,ODI,MAI,NREM-AHI,and AHI of the mild to moderate and severe EDS groups were higher than those of the non-EDS group(P<0.05 for all).The postural dependence index of the severe EDS group was significantly lower than that of the non-EDS group,and CT90%was higher than that of the mild to moderate EDS group(all P<0.05).ESS scores in the three groups were positively correlated with supine AHI,non-supine AHI,CT90%,ODI,MAI,NREM-AHI,AHI,BMI,neck circumference and hypertension(r-0.201,0.332,0.421,0.301,0.273,0.292,0.305,0.211,0.389,0.294 rspectively,all P<0.05),and negatively correlated with postural dependence index(r=-0.282,P<0.05).Multivariate analysis showed that MAI was an independent risk factor for the incidence of mild to moderate EDS(OR=1.036,P<0.05),and neck circumference was an independent risk factor for the incidence of severe EDS(OR=1.285,P<0.05).CONCLUSION Sleep position,neck circumference,hypertension,nocturnal hypoxemia,and arousal are all factors influencing the development of EDS in patients with moderate to severe OSA.Non-supine AHI directly reflects the severity of EDS in patients with moderate to severe OSA more than supine AHI,and the postural dependence index is closely related to the occurrence of severe EDS.