阻塞性睡眠呼吸暂停综合征对肥胖病人肺功能的影响分析

Effect of obstructive sleep apnea syndrome on pulmonary function in obese patients

目的探讨阻塞性睡眠呼吸暂停综合征(obtructive sleep apnea,OSAHS)对肥胖病人肺功能的影响。方法选取2018年9月至2022年4月徐州医科大学附属医院睡眠中心就诊的160例肥胖病人,行多导睡眠监测(polysomnography,PSG)、肺功能检查及血液相关化验,依据呼吸暂停低通气指数(apnea hypopnea index,AHI)分为四组:单纯肥胖组(33例)、肥胖合并轻度OSAHS组(31例)、肥胖合并中度OSAHS组(32例)、肥胖合并重度OSAHS组(64例),分析年龄、身体质量指数(BMI)、Epworth嗜睡量表(epworthsleepiness scale,ESS)、AHI、平均血氧饱和度(MSaO_(2))、最低血氧饱和度(LSaO_(2))、最长呼吸暂停时间(LAT)、各项肺功能指标。结果与单纯肥胖组相比,肥胖合并重度OSAHS组肺总量(TLC)[(82.27±13.89)L比(91.30±8.94)L]、重度组肺活量、用力肺活量(FVC)、补呼气容积(ERV)显著减低(P<0.05)。校正BMI、年龄后,AHI与肺活量、FVC、TLC、功能残气量(FRC)呈负相关(P<0.05),AHI与一秒率(FEV_(1)/FVC)、每升肺泡容积的一氧化碳弥散量(Kco)呈正相关(P<0.05);MSaO_(2)与肺活量、FVC、TLC及第1秒用力呼气容积(FEV_(1))呈正相关(P<0.05);LSaO_(2)与肺活量、FVC、ERV、FEV_(1)、TLC、FRC呈正相关(P<0.05),LSaO_(2)与Kco呈负相关(P<0.05)。多因素逐步回归分析结果显示AHI对FVC具有显著影响(P<0.05),LSaO_(2)、MSaO_(2)对肺活量、TLC具有显著影响(P<0.05),LSaO_(2)、BMI对FEV_(1)具有显著影响(P<0.05),AHI、BMI对Kco具有显著影响(P<0.05)。结论对于患有OSAHS的肥胖病人,尤其是严重OSAHS病人,其多项肺功能指标明显下降;AHI是肥胖病人肺功能指标FVC的独立危险因子,LSaO_(2)是肥胖病人肺活量、TLC、FEV_(1)损害的独立危险因子。AHI和LSaO_(2)可能成为肥胖合并OSAHS病人肺功能损害的预测因子,肺功能检查可以作为肥胖病人OSAHS严重程度的辅助评估手段。

Objective To study the effects of obstructive sleep apnea(OSAHS)on lung function in obese patients.Methods One hundred and sixty obese patients who underwent polysomnography(PSG),pulmonary function examination and blood related tests who admitted to the Sleep Center of Affiliated Hospital of Xuzhou Medical University from September 2018 to April 2022 were selected.They were assigned into four groups according to apnea hypopnea index(AHI):simple obesity group(33 cases),obese patients with mild OSAHS(31 cases),obese patients with moderate OSAHS(32 cases)and obese patients with severe OSAHS(64 cases).Epworth Sleepiness Scale(ESS),AHI,mean saturation oxygen(MSaO_(2)),lowest arterial saturation oxygen(LSaO_(2))longest apnea time(LAT),and various pulmonary function indicators were analyzed.Results Compared with the simple obesity group,the total lung volume(TLC)[ratio of(82.27±13.89)vs.(91.30±8.94)L],vital capacity(VC),forced vital capacity(FVC)and expiratory volume(ERV)in the obesity combined with severe OSAHS group were significantly decreased(P<0.05).After adjusting for BMI and age,AHI was negatively corre⁃lated with VC,FVC,TLC and FRC(P<0.05),and significantly positively correlated with FEV_(1)/FVC and Kco(P<0.05);MSaO_(2) was posi⁃tively correlated with VC,FVC,TLC and FEV_(1)(P<0.05);LSaO_(2) was positively correlated with ERV,VC,FVC,FEV_(1),TLC,FRC(P<0.05)and LSaO_(2) was negatively correlated with Kco(P<0.05).Multivariate stepwise regression analysis showed that AHI had signifi⁃cant effects on FVC(P<0.05),LSaO_(2) and MSaO_(2) had significant effects on VC and TLC(P<0.05),LSaO_(2) and BMI had significant ef⁃fects on FEV_(1)(P<0.05),and AHI and BMI had significant effects on Kco(P<0.05).Conclusions The severity of OSAHS in obese pa⁃tients is closely associated with various respiratory dysfunctions,and AHI is an independent risk factor for FVC of lung function in obese patients.LSaO_(2) is an independent risk factor for VC,TLC and FEV_(1) of lung function in obese patients.AHI and LSaO_(2) may be⁃come predictors of pulmonary function damage in obese patients with OSAHS,and pulmonary function tests can be an adjunct to assess⁃ing the severity of OSAHS in obese patients.