亚高原地区阻塞性睡眠呼吸暂停低通气综合征患者右心功能评估及持续正压通气治疗效果评价

Assessment of the right heart function and effects of continuous positive pressure ventilation in obstructive sleep apnea hypopnea syndrome patients in subplateau regions

目的睡眠期间反复的气道阻塞可影响右心室功能,高海拔条件下的缺氧环境可进一步加剧阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对肺循环的影响,本研究拟评估亚高原地区OSAHS患者右心功能,评价持续正压通气(CPPV)的治疗效果。方法选取OSAHS患者60例,健康志愿者30例,均行多导睡眠监测,常规超声、超声心动图显像指标数据采集。其中15例有CPAP治疗适应症并自愿接受的OSAHS患者每晚使用CPPV治疗至少6 h,并且不间断CPPV治疗至少6个月。结果与对照组比较,OSAHS组患者右心房心肌纵向应变曲线(RALS)、右心室整体心肌应变曲线(RVGLS)绝对值、右心室射血分数(RVEF)均降低,并且RVGLS和RVEF是OSAHS疾病严重程度的独立预测因子;CPPV治疗后,RVGLS绝对值、RALS、RVEF、夜间最低动脉血氧饱和度、夜间平均动脉血氧饱和度显著增加(P <0.05)。结论亚高原地区OSAHS组右心室功能发生异常,与OSAHS严重程度相关, CPPV治疗可以改善亚高原地区OSAHS患者右心室功能。

Objective It is known that repetitive obstruction of larynx during sleep can affect one’s right heart performance.High altitude can aggravate the effects of obstructive sleep apnea hypopnea syndrome(OSAHS)on pulmonary circulation,since altitude-related hypoxia is related to pulmonary vasoconstriction.This study was to evaluate the right heart function of OSAHS patients in subplateau regions and to evaluate the effect of continuous positive pressure ventilation(CPPV).Methods Sixty OSAHS patients and 30 healthy volunteers were studied.All individuals were performed with polysomnography,data of echocardiography and conventional echocardiography were collected.Among them,15 patients with CPPV indications and having voluntarily accepted OSAHS were treated with CPPV for at least 6 hours every night and continuously for at least 6 months.Results Compared with the control group,the right atrial longitudinal strain(RALS),right ventricular global longitudinal strain(RVGLS)absolute value and right ventricular ejection fraction(RVEF)of patients in OSAHS group all decreased,RVGLS and RVEF were independent predictors of OSAHS disease severity.After CPPV treatment,RVGLS absolute value,RALS,RVEF,nocturnal minimum arterial oxygen saturation and nocturnal average arterial oxygen saturation were significantly increased(P<0.05).Conclusion Right ventricular function was abnormal in OSAHS patients in subplateau regions and associated with OSAHS severity.CPPV treatment can improve right heart function in OSAHS patients in those regions.