老年人睡眠呼吸暂停综合征醒觉特点探讨

Study of arousal in aged people with sleep apnea syndrome

目的 探讨老年睡眠呼吸暂停综合征 (SAS)患者醒觉 (arousal)与呼吸暂停的关系。 方法 62例老年患者经全导睡眠图检查确诊为SAS ,同时记录实际睡眠时间、呼吸暂停 低通气指数(AHI)、总醒觉发生次数、醒觉指数 (AI)、呼吸事件相关醒觉次数、>15s觉醒次数、低氧血症程度等 ;64例非老年SAS患者作为对照。 10例老年患者应用经鼻持续气道正压 (nCPAP)治疗 ,比较治疗前、后上述各项指标的变化。 结果 62例老年SAS患者平均AHI为 (3 5 1± 2 3 2 )次 /h ,平均AI为 (15 8±11 4)次 /h ,其中呼吸相关醒觉只占总醒觉的 44 1% ,>15s的觉醒只占总醒觉的 6 1% ;64例非老年组平均AHI为 (3 9 1± 2 7 2 )次 /h ,平均AI为 (2 0 4± 13 0 )次 /h ,呼吸相关醒觉占总醒觉的 5 1 3 % ,>15s的觉醒占总醒觉的 6 7%。老年及非老年SAS组中均有 5 0 %患者发生重度低氧。老年组的醒觉指数和呼吸相关醒觉均显著低于非老年组 (P <0 0 5 )。 10例老年患者经使用nCPAP治疗后 ,AHI、AI、呼吸事件相关醒觉次数及其占总醒觉比例、>15s觉醒次数及其占总醒觉比例均比治疗前明显减低(P <0 0 1)。 结论 老年SAS患者对睡眠中频繁出现的呼吸事件的反应降低 ,甚至不能作出反应 ,睡眠中频繁出现低氧血症 。

Objective To study the relationship between arousal and sleep apnea in old people with sleep apnea syndrome(SAS). Methods Sixty-two aged patients were diagnosed of SAS after polysomnography (PSG). Records included total sleep time, apnea-hypopnea index(AHI),total arousal number(TAN), arousal index(AI), total respiratory-related arousal number(TRAN), total number of arousal lasted over 15 seconds (T15AN) and the severity of hypoxemia (desaturation). Sixty-four non-aged patients were included in control group. Ten aged patients were intervened with nasal continuous positive airway pressure (nCPAP) treatment. Data were compared with that before treatment. Results The results for the above parameters of the aged and the non-aged SAS patients were( 35.1±23.2)/h and (39.1±27.2)/h respectively for AHI, (15.8±11.4)/h and (20.4±13.0)/h for AI, 44.1% and 51.3% for the ratio of TRAN/TAN, only 6.1% and 6.7% for ratio of T15AN/TAN. 50% of 62 aged and 64 non- aged SAS patients were in severe desaturation. The AI and TRAN of the aged patients were significantly lower than that of non-aged patients (P<0.05). Of those 10 aged SAS patients who were treated with nCPAP, their AHI, AI, TRAN and ratio of TRAN/TAN, T15AN and ratio of T15AN/TAN were all significantly decreased (P<0.01). Conclusions There are little arousals occurred in the aged SAS patients comparing with the non-aged SAS patients, suggesting that the responses to the respiratory events which occur during sleep is declined or even failed in the aged SAS patients. Desaturation would happen repeatedly. nCPAP can correct respiratory events and reduce the happening of arousal effectively. Therefore, in time drug intervention is necessary to the aged patients with SAS.