快动眼睡眠期相关阻塞性睡眠呼吸暂停综合征人群特征的研究  

Clinical and Polysomnographic Characteristics of Patients with Rapid Eye Movement Sleep Disordered Breathing

作　　者：叶京英[1] 韩德民[1] 李彦如[1] 曹鑫[1] 刘志勇[1] 丁秀[1] 张玉焕[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室

出　　处：《首都医科大学学报》2009年第6期746-751,共6页Journal of Capital Medical University

基　　金：国家自然科学基金(30730100)资助项目~~

摘　　要：目的研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者呼吸事件发生与睡眠时相的关系,探索快动眼睡眠期(REM)依赖的OSAHS患者的临床和多导睡眠图特征。方法OSAHS患者417例,行多导睡眠监测,以REM期呼吸暂停低通气指数(AHI)和非快动眼睡眠期(NREM)AHI的比例表示呼吸事件的REM期主导度。分析患者REM期和NREM期AHI和呼吸事件维持时程的差异以及REM期主导度与睡眠监测参数的相关性;比较REM依赖患者(定义为REM期主导度≥2)与其他患者临床特征的差异。结果患者总体REM期和NREM期AHI比较差异无统计学意义(t=-0.361,P=0.718),呼吸暂停低通气时间指数(AHTI)差异有统计学意义(t=5.784,P=0.000)。229例(55.0%)患者REM期AHI小于NREM期,286例患者(68.6%)REM期AHTI大于NREM期。REM期主导度与AHI显著相关(r=-0.234,P=0.000)。REM依赖的OSAHS患者(67例/16.7%)与其他患者(350例)的AHI(t=10.708),觉醒指数(t=6.070),最低血氧饱和度(t=-5.989),阻塞性呼吸暂停事件比例(t=4.282),颈围(t=2.181)、ESS评分(t=2.772)及体质量指数(t=2.858)差异有统计学意义,而REM睡眠期比例和年龄差异无统计学意义。结论在REM睡眠期多数OSAHS患者存在呼吸事件时程的增长而非单纯的呼吸事件频率的增加。REM睡眠依赖的OSAHS患者AHI相对较低,病情严重度较轻。Objective To test the hypothesis that there would be a subgroup of patients who have rapid eye movement（REM） predominance of obstructive events and that these subjects share certain clinical characteristics and to assess factors influencing the distribution of events by sleep state in patients with obstructive sleep apnea（OSA）. Methods Polysomnography recordings of 417 adults with OSA were reviewed. Apnea hypopnea index（AHI） and duration of respiratory events were calculated separately for REM and non-REM（NREM） sleep and compared. A REM predominance index（RPI） was determined using REM/NREM AHI and its possible influencing factors were investigated. REM sleep related OSA was defined as RPIor=2. Their polysomnography data and clinical characteristics were compared with other subjects. Results There was no significant difference between AHI in REM vs NREM sleep（t=-0.361,P=0.718）. But the difference in apnea-hypopnea time index（AHTI） was significant at the 0.01 level（t=5.784）. Higher AHI in NREM than REM sleep was found in 229（55.0%） patients; 286 patients（68.6%） had a higher AHTI in REM sleep than NREM sleep. Analysis showed that RPI was significantly correlated with AHI（r=-0.234,P=0.000）. Sixty-seven subjects were REM sleep related OSA patients（16.7%）. Differences existed in AHI（t=10.708）,arousal index（t=6.070）,nadir SaO2（t=-5.989）,proportion of obstructive apnea index to AHI（t=4.282）,ESS score（t=2.772） and BMI（t=2.858） between REM sleep related OSA patients and the other subjects. There was no significant difference between sleep state distribution and age. Conclusion The duration of respiratory events was longer in REM sleep than in NREM sleep while AHI was similar. REM sleep-related OSA is a problem in only the patients with mild and moderate disease.

关 键 词：睡眠呼吸暂停 阻塞性呼吸暂停 快动眼睡眠 睡眠时相 主导度 多导睡眠监测 患者 呼吸暂停低通气指数 睡眠期 统计学意义 

分 类 号：R56[医药卫生—呼吸系统]