阻塞性睡眠呼吸暂停低通气综合征患者夜间碱反流初步研究

A preliminary study on nocturnal alkali reflux in OSAHS patients

目的 咽喉反流与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome, OSAHS)往往存在较高的伴发率,探讨OSAHS患者夜间碱反流特点。方法 回顾性分析98例鼾症患者夜间睡眠时口咽pH值监测并同步多导睡眠监测结果,分析pH值>7.5异常高pH值事件与鼾症严重程度相关性,并留取晨起唾液使用酶联免疫法进行胰蛋白酶检测。结果 根据口咽pH值监测结果,存在夜间睡眠pH值>7.5高pH值事件33例。OSAHS组出现高pH值事件39.0%(32/82),高于单纯鼾症组6.3%(1/16),经比较显示差异有统计学意义(P=0.011),两组间高pH值事件百分比时间及最高pH值比较显示差异有统计学意义(P=0.020,0.020)。晨起胰蛋白酶检测结果27.42~401.44μg/L,其中17例异常增高(275.28±59.13)μg/L,OSAHS组与单纯鼾症组比较差异无统计学意义,但存在高pH值事件的32例OSAHS患者,按打鼾程度分组,组间胰蛋白酶含量比较差异有统计学意义(P=0.048)。结论 口咽pH值监测发现OSAHS患者夜间睡眠时更易出现异常的高pH值事件,晨起唾液亦可检出异常增高的胰蛋白酶,提示发生碱性反流可能,但发生机制还需进一步研究。

Objective Patients with obstructive sleep apnea and hypopnea syndrome(OSAHS)often have a high incidence of laryngopharyngeal reflux,the purpose of this study was to investigate the characteristics of nocturnal alkali reflux in OSAHS patients.Methods The results of oropharyngeal pH monitoring and simultaneous polysomnography in 98 patients with snoring were analyzed retrospectively.The correlation between abnormally high pH events with pH>7.5 and severity of sleep ventilation disorders was analyzed.Saliva samples were reserved in the morning for trypsin detection by enzyme-linked immunosorbent assays.Results Oropharyngeal pH monitoring results found 33 cases with high pH events(pH>7.5)during nocturnal sleep.The occurrence of high pH events in the OSAHS group was 39.0%(32/82),which was significantly higher than the pure snoring group(6.3%,1/16)(P=0.011),and similar results were seen with the percentage time of high pH events and the highest pH values(P=0.020,0.020).Mean salivary trypsin levels were 27.42-401.44μg/L,of which 17 cases were abnormally increased(275.28±59.13)μg/L.There was no significant difference between the OSAHS and pure snoring groups in trypsin content,but the trypsin content in the 32 OSAHS patients with high pH events differed statistically based on the degree of snoring(P=0.048).Conclusion OSAHS patients were prone to nocturnal high pH events,as revealed through oropharyngeal pH monitoring and abnormally increased saliva trypsin contents in the morning,suggesting that alkaline reflux may occur.However,the mechanisms of alkaline reflux need to be further studied.