老年人阻塞性睡眠呼吸暂停低通气综合征的临床特点

Clinical characteristics of elderly patients with obstructive sleep apnea hypopnea syndrome

目的 探讨老年人阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)的临床特点。 方法 随机抽取经多导睡眠图 (PSG)监测诊断为OSAHS的老年和青年 (作对照 )病人各 5 0例 ,研究比较两组的患病因素、临床表现、合并症及PSG监测结果。 结果 两组体重指数 (BMI)差异无显著性 (P >0 .0 5 )。合并症 (高血压、心脏病、糖尿病、呼吸系疾病 ) ,老年组明显多于青年组。主要临床表现 ,老年组有打鼾 96 %、夜间憋醒 5 0 %、白天嗜睡 74 %、记忆力下降 80 %、反映迟钝 30 %、夜尿增多 2 8%,而青年组则以打鼾、白天嗜睡为主。PSG监测结果 ,两组入睡潜伏期、快动眼睡眠及最低血氧饱和度相比 ,差异无显著性 (P >0 .0 5 )。老年组唤醒次数 39.4± 19.6 ,非快动眼睡眠 (SⅠ -Ⅱ) 70 .0 %± 12 .1%,(SⅢ -Ⅳ) 10 .9%± 9.8%、氧减饱和度指数(ODI) 36 .3± 2 0 .5、呼吸紊乱指数 (AHI) 32 .3± 18.1,与青年组相比 ,差异有显著性 (P <0 .0 5 )。 结论 (1)男性、肥胖是老年人OSAHS的重要易患因数 ;(2 )老年人OSAHS有较高的合并症 ,临床上易漏诊或误诊 ;(3)老年人OSAHS的临床表现易与一般衰老症状相混淆 ,应注意鉴别 ;(4)PSG监测反映出来的反复呼吸暂停、低通气所引起的低氧血症、睡眠结构紊乱是引起各种合并症和临床症状的病理?

Objective To explore the clinical characteristics of elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods One hundred patients with OSAHS detected by PSG were divided randomly into two groups, fifty cases in elderly group and fifty in young group as controls. The nosogenesis, clinical manifestations, complications and the results of PSG monitoring were compared between them. Results There was no significant difference in BMI (P>0.05) between elderly patients and controls, but the incidences of complications such as hypertension,heart diseases,diabeties millitus, and respiratory diseases in elderly group were increased remarkably. The clinical manifestations in elderly group were: snore (96%),oppresive wake (50%),excessive sleepiness during the day (74%), forgetfulness (80%), poor judgement (30%),night urine increased (28%),et al.The controls mainly presented snore (100%),excessive sleepiness during the day (68%),et al.PSG monitoring showed that there were no significant differences between two groups in sleep latency, rapid eye movement sleep and lowest saturation in arterial blood (P>0.05),but there were significant differences in the number of arousal, nonrapid eye movement sleep, oxygen desaturation index and apnea-hypopnea index. Conclusion Male and Fatness are the important factors that cause elderly people suffered from OSAHS. Elderly patients with OSAHS have more chances to get complications than the contonls,which may induce misdiagnosis. Hypoxemia and sleep architecture disorder induced by repeated sleep apnea, hypopnea are path physiological basis of the various complications and clinical manifestation.We should pay more attention to the early diagnosis of OSAHS in elderly people.