阻塞性睡眠呼吸暂停低通气综合征快动眼与非快动眼分型的多道睡眠图分析  

Rapid eye movement-related and none rapid eye movement-related classification in obstructive sleep apnea hypopnea syndrome

作　　者：柴丽萍[1] 谢绚[1] 曾宇慧[1] 王章锋[1] 涂秀平[1] 

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院中山大学耳鼻咽喉科研究所,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第2期105-110,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的通过比较阻塞性睡眠呼吸暂停低通气综合征（OSAHS）快动眼（REM）与非快动眼（NREM）分型的多道睡眠图（PSG）分析，探讨OSHAS的发生机制。方法采用Siddiqui方法，将137例成年OSAHS患者根据不同睡眠期的呼吸暂停低通气指数（AHI）分为REM型（REM期AHVNREM期AHI〉1）及NREM型（REM期AHVNREM期AHI〈1），比较两型问总体及各程度分组中PSG参数的差异。结果REM型OSHAS患者72例（52．6％），NREM型65例（47．4％）。REM型OSAHS患者的AHI和NREM期AHI较NREM型患者低，而最低血氧饱和度（lowest arterial oxygen sanration，LSaO2）、REM期LSaO2和NREM期LSaO2均较NREM型高（t值分别为-6．466、-7．638、3．426、2．472和4．873，P值均〈0．05）；两型间的睡眠结构、REM期AHI的差异无统计学意义（P值均〉0．05）。OSAHS轻、中、重3组中，REM型的构成比呈下降趋势，分别为77．8％、61．5％、37．3％；NREM型的构成比则逐渐升高，分别为22．7％、38．5％、62．7％（X2=16．996，P〈0．01）。轻度组与中度组中，NREM型OSAHS患者的REM期LSaO2较REM型高，差异有统计学意义（t值分别为-4．273和-2．136，P值均〈0．05），两型间AHI、LSaO2、NREM期LSaO2的差异均无统计学意义（P值均〉0．05）。重度组中NREM型患者的AHI高于REM型，而LSa02、REM期LSaO2及NREM期LSaO2则低于REM型，差异均有统计学意义（t值分别为-4．943、2．574、1．996和3．571，P值均≤0．05）。两型OSAHS患者的睡眠潜伏期、睡眠有效率差异均无统计学意义（P值均〉0．05）。结论REM型主要分布于轻、中度OSAHS，而NREM型主要分布于重度OSAHS，NREM型患者的呼吸事件发生率、缺氧情况可能更重些。发生于不同睡眠分期的呼吸暂停可能对患者的睡眠结构、睡眠效率及睡眠潜伏期影响不大。Objective To study the value of a new measurement that divided obstructive sleep apnea-hypopnea syndrome （OSAHS） into rapid-eye-movement （REM） related and non-rapid-eye-movement （NREM） related subgroups. Methods According to Siddiqui classification, 137 adult patients with OSHAS were diagnosed as REM-related OSAHS [ REM apnea hyponea index （AHI）/NREM AHI 〉 1 ] or NREM-related OSAHS （ REM AHI/NREM AHI 〈 1 ）. Polysomnographic data were compared and discussed. Results （~）There were 72 cases defined as REM-related OSAHS （52.6%） and 65 cases defined as NREM- related OSAHS （47. 4% ）. （2）In all cases, total AHI and NREM AHI in REM-related OSAHS were significantly lower than those in NREM-related OSAHS, while lowest arterial oxygen saturation （ LSaO2 ）, REM LSaO2 and NREM LSaO2 were significantly higher than those in NREM-related OSAHS （t were - 6. 466, - 7. 638, 3. 426, 2. 472, 4. 873 respectively, P 〈 0.05 ）. No significance was found in sleep structure, REM AHI and REM LSaO2 between REM-related and NREM-related OSAHS （ P 〉 0.05 ）. （3） Given the severity of OSHAS, the constituent ratio of REM-related OSAHS decreased （77.8% ,61.5%, 37.3% ） from mild to severe OSAHS, while that of NREM-related OSAHS rose （22.7% ,38.5% ,62.7% ;χ2 = 16. 996, P 〈 0. 01 ）. In mild and moderate groups, REM LSaO2 of REM-related OSAHS was significantly lower than those in NREM-related OSAHS （t were -4. 273 and -2. 136, P 〈0.05）, while the differences of total AHI and LSaO2 ,NREM LSaO2 between these two types were not significant. In severe group, AHI in NREM-related OSAHS was significantly higher than that in REM-related OSAHS, while LSaO2,REM LSaO2 and NREM LSaO2 was significantly lower than those in REM-related OASHS （t were -4.943, 2. 574, 1. 996, 3. 571, P≤0.05）. （4）There was no significance in sleeping latency and efficiency between REM-related and NREM-related OSHAS. Conclusions REM-related OSHAS mainly exists in mild and moderate OSHAS, while NREM-rela

关 键 词：睡眠 快速眼运动 多道睡眠描记术 睡眠呼吸暂停 阻塞性 

分 类 号：R766[医药卫生—耳鼻咽喉科]