鼾症患者前后半夜多导睡眠监测参数的对比分析

Comparative analysis of polysomnography parameters between the first and second halves of the night in snoring patients

目的 对比分析包括阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)在内的鼾症患者的多导睡眠监测(polysomnography, PSG)主要参数在前半夜与后半夜之间是否存在差异,明确分夜诊断结果是否能准确反映患者整夜数据。方法 选取2022年4~5月期间以睡眠打鼾就诊并接受整夜PSG检查的患者为研究对象,所有入组患者完成标准的整夜PSG检查。以凌晨2点为前后半夜分界线,分别获取前后半夜的PSG结果并进行对比分析。结果 以呼吸暂停低通气指数(apnea hypopnea index, AHI)为依据,本研究最终共纳入47例OSAS患者(AHI≥5次/h)及16例单纯鼾症患者(AHI<5次/h);与后半夜相比,OSAS患者前半夜AHI、氧减指数(oxygen desaturation index, ODI)、微觉醒指数(micro-arousal index, MAI)显著较高,平均血氧水平(average blood oxygen level, ASAT)显著较低,N2及N3期睡眠比例显著较高,REM期睡眠比例显著较低(P均<0.05);16例单纯鼾症患者前半夜仅N3期睡眠比例显著较高及REM期睡眠比例显著较低(P均<0.05),余PSG参数对比差异均无统计学意义。OSAS患者前后半夜AHI差值(△AHI)范围为-19.6~52.4次/h,中位值4.9 (-2.3, 10.7)次/h,进一步分析发现△AHI与各睡眠分期差异均无显著相关性(P>0.05)。△AHI值绝对值(|△AHI|)≥10次/h患者的例数可达16例(34.0%),相对于|△AHI|<10次/h的患者,|△AHI|≥10次/h的患者其前半夜AHI、ODI以及MAI均显著较高(P<0.05)。结论 OSAS患者前后半夜疾病严重程度存在显著差异,在前半夜疾病严重程度较重的患者中这种差异更为明显,提示前半夜PSG检查数据作为后续治疗参考并不可靠,单纯鼾症患者中上述现象并不明显。

Objective To compare and analyze the differences in the critical parameters of polysomnography(PSG)between the first and second halves of the night in patients with snoring,including those with obstructive sleep apnea syndrome(OSAS),and to clarify whether the split-night diagnostic results can accurately reflect the patient's overnight status.Methods Patients who presented with sleep snoring and who underwent overnight PSG examination from April to May 2022 were selected as the study population.All of the enrolled patients completed standard overnight PSG examinations.The study period of one night was split into the first and second halves using 2 a.m.as the dividing point,and the relevant PSG parameters of both halves were compared and analyzed.Results Based on the apnea hypopnea index(AHI),a total of 47 patients with OSAS(AHI≥5 times/h)and 16 patients with simple snoring(AHI<5 times/h)were included.In patients with OSAS,the AHI,oxygen desaturation index(ODI),micro-arousal index(MAI),and proportion of N2 and N3 sleep were significantly higher;whereas,the average blood oxygen level and proportion of rapid eye movement(REM)sleep were significantly lower(P<0.05)during the first half compared with the second half of the night.However,in the 16 patients with simple snoring,only the proportion of N3 sleep was significantly higher and the proportion of REM sleep was significantly lower(all P<0.05)during the first half in comparison with the second half of the night.The difference in AHI(△AHI)before and after midnight in the patients with OSAS ranged from-19.6 to 52.4 times/h,and the median value was 4.9(-2.3,10.7)times/h.Further analysis showed that△AHI was not significantly correlated with different sleep stages(P>0.05).There were 16 patients(34.0%)with an absolute value of△AHI(|△AHI|)≥10 times/h.Patients with|△AHI|<10 times/h had significantly higher AHI,ODI,and MAI during the first half of the night(P<0.05)than those with|△AHI|≥10 times/h.Conclusion There was a significant difference in the severity of disease between the first and second halves of the night in the patients with OSAS;this difference was more pronounced during the first half in those with a more severe disease.The results indicated that the PSG data from the first half of the night was not reliable for guiding subsequent treatment.Meanwhile,the aforementioned phenomenon was not obvious in the patients with simple snoring.