吸烟与阻塞性睡眠呼吸暂停的相关性分析

Correlation analysis between smoking and obstructive sleep apnea

目的研究吸烟与阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的相关性。方法回顾性收集2015年10月—2021年7月间因睡眠问题就诊的454例患者,行夜间多导睡眠监测(均不少于7 h)。根据多导睡眠监测结果,将患者分为OSA组(405例)和对照组(单纯鼾症患者49例)。参考呼吸暂停低通气指数(apnea-hypopnea index,AHI)及睡眠期间最低血氧饱和度对OSA的严重程度进行分度,分为轻中度组(5次/h≤AHI<30次/h)和重度组(AHI≥30次/h)。详细询问并记录吸烟史,将诊断为OSA的患者根据其吸烟史再分为吸烟组、已戒烟组、不吸烟组。结果OSA组患者吸烟率高于对照组(50.9%比32.7%,P<0.05),重度OSA组的患者吸烟率高于轻中度组(55.7%比39.8%,P<0.05)。吸烟与AHI、血氧饱和度低于90%时间占总睡眠时间百分比(cumulative percentages of time spent at oxygen saturation below 90%,Ts90%)、总呼吸暂停时间呈正相关(r值分别为0.196、0.197、0.163,P<0.05),与睡眠期间最低脉搏血氧饱和度(SpO2)、平均SpO2呈负相关(r值分别为–0.202、–0.214,P<0.05)。以重度OSA为结局变量的Logistic回归分析结果显示吸烟[比值比(odds ratio,OR)=1.781]、肥胖(OR=1.930)是重度OSA的独立危险因素(P<0.05)。OSA患者不同吸烟状态组间对比,吸烟组重度OSA所占比例、AHI、Ts90%、总呼吸暂停时间(分别为77.8%、53.55次/h、18.35%、111.70 min)均大于不吸烟组(分别为62.8%、40.20次/h、8.40%、76.20 min,P<0.05),睡眠期间最低SpO2、平均SpO2(分别为69.50%、93.00%)均小于不吸烟组(分别为75.00%、94.00%,P<0.05);已戒烟组平均SpO2高于吸烟组(94.00%比93.00%),Ts90%小于吸烟组(6.75%比18.35%),差异均有统计学意义(P<0.05)。结论吸烟明显影响睡眠呼吸障碍程度,吸烟可能是重度OSA的独立危险因素。吸烟可加重OSA严重程度及缺氧程度,戒烟可改善OSA患者缺氧程度。

Objective To study the correlation between smoking and obstructive sleep apnea(OSA).Methods A total of 454 patients from October 2015 to July 2021 were retrospectively collected for nocturnal polysomnography monitoring(no less than 7 hours).The patients were divided into an OSA group(n=405)and a control group(n=49,patients with primary snoring)according to the results of polysomnography monitoring.According to the apnea hypopnea index(AHI)and the lowest oxygen saturation during sleep,the severity of OSA was classified into a mild to moderate group(5 times/h≤AHI<30 times/h)and a severe group(AHI≥30 times/h).The patients were inquired about their smoking history,then the patients diagnosed with OSA were further divided into a smoking group,a smoking cessation group,and a non-smoking group based on their smoking history.Results The smoking rate of the patients in the OSA group was higher than that in the control group(50.9%vs.32.7%,P<0.05),while the smoking rate in the severe OSA group was higher than that in the mild to moderate group(55.7%vs.39.8%,P<0.05).Smoking was positively correlated with AHI,cumulative percentages of time spent at oxygen saturation below 90%(Ts90%),and total apnea time(r value was 0.196,0.197,0.163,P<0.05),while negatively correlated with the lowest and average SpO2 during sleep(r value was–0.202,–0.214,P<0.05).The logistic regression analysis with severe OSA as the outcome variable showed that smoking(OR=1.781)and obesity(OR=1.930)were independent risk factors of severe OSA(P<0.05).The comparison between groups of the OSA patients with different smoking states showed that the proportion of severe OSA,AHI,Ts90%,and total apnea time(77.8%,53.55 times/h,18.35%,and 111.70 minutes,respectively)of the smoking group were higher than those of the non-smoking group(62.8%,40.20 times/h,8.40%,and 76.20 minutes,respectively,P<0.05).The lowest SpO2 and average SpO2 during sleep(69.50%,93.00%,respectively)of the smoking group were lower than those of the non-smoking group(75.00%,94.00%,respectively,both P<0.05).The average SpO2 of the smoking cessation group was higher than that of the smoking group(94.00%vs.93.00%,P<0.05),and the Ts90%of the smoking cessation group was lower than that of the smoking group(6.75%vs.18.35%,P<0.05).Conclusions Smoking significantly affects the degree of sleep-disordered breathing and may be an independent risk factor for severe OSA.Smoking can exacerbate the severity of OSA and the degree of hypoxia,while smoking cessation can improve the degree of hypoxia in OSA patients.