阻塞性睡眠呼吸暂停低通气综合征女性患者呼吸事件与睡眠时相的关系

Relationship between Sleep Phase and Occurance of Sleep Apnea Events in Female Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

目的:探讨女性不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床特征以及呼吸事件与睡眠时相的关系。方法:主诉睡眠打鼾的女性患者56例,根据夜间多导睡眠图(PSG)监测结果分为4组,即单纯性鼾症组(AHI<5次/h)、轻度、中度和重度OSAHS组。对症状、绝经与否、合并症、Epworth嗜睡量表(ESS)评分、颈围、体重指数(BMI)以及PSG监测指标进行比较;自行设计程序,计算并比较睡眠时相中呼吸事件发生的频率和持续时间以及微觉醒指数。结果:①4组间平均年龄、打鼾病史、BMI、颈围、症状、ESS评分、绝经者所占百分率及合并症出现比率差异无显著性(P>0.05)。②各组总睡眠时间、S1、S2、S3以及快速眼动相(REM期)占总睡眠时间的百分比差异无显著性(P>0.05)。③轻、中度组睡眠不同时相的呼吸事件发生的频率、微觉醒指数及REM明显高于非快速眼动相(NREM期)(P<0.05)。呼吸事件持续时间,重度组REM期明显长于NREM期(P<0.01)。结论:①目前临床诊断和评估的指标不能或不能完全提示女性OSAHS患者的轻重程度;②女性患者呼吸事件主要发生在REM期,该期可能具有重要意义,这一推断有助于对相应的治疗进行进一步探讨。

Objective:To study the clinical characteristics and relationship between sleep phase and occurance of sleep apnea events in female patients with various degree of obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:Fifty-six women suffered from snoring were divided into4groups according to pdysomnogram(PSG)results,such as a group of sin-gle snoring(apnea and hypopnea index,AHI<5/h),and groups of mild,moderate and severe OSAHS.The history of snor-ing,main symptoms,pre-or post-menopause,accompanied diseases,Epworth sleepiness scale(ESS),neck collar,body mass index(BMI)and parameters of the PSG were studied.Frequency and duration of apnea and hypopnea,micro-arousal index during phases of rapid eye movement(REM)and nonrapid eye movement(NREM)were compared among the groups.Results:①There was no significant difference among the4groups in history of snoring,main symptoms,status of menopause,ESS,BMI and accompanied diseases(P>0.05).②The total sleep time(TST),proportion of different stage(S 1 ,S 2 ,S 3 )and REM had no significant difference among these groups(P>0.05).③In both mild and moderate groups,the fre-quency of apnea events and micro-arousal index in REM were significantly higher than that in NREM(P<0.05).In group of severe patients,the duration of apnea events in REM was significantly longer than that in NREM(P<0.01).Conclu-sions:①The degree of OSAHS in female patients may not or in completely be determined by current clinical diagnostic and assessment indexes.②It is demonstrated that the sleep apnea events are mostly happened in REM in female patients,this phase may have unique significance and may be helpful in treatment of OSAHS.