飞行人员阻塞性睡眠呼吸暂停低通气综合征多导睡眠监测及治疗前后对比  

Polysomnography in pilots with obstructive sleep apnea-hypopnea syndrome before and after treatment

作　　者：崔丽[1] 王莞尔[1] 徐先荣[1] 王勇[2] 张扬[1] 刘玉华[1] 王建昌[1] 

机构地区：[1]空军总医院,北京100142 [2]解放军第309医院旃坛寺门诊部,北京100034

出　　处：《解放军医学院学报》2014年第8期793-795,805,共4页Academic Journal of Chinese PLA Medical School

基　　金：全军后勤科研"十二五"重大项目(AKJ11J004)~~

摘　　要：目的分析飞行人员阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea/hypopnea syndrome,OSAHS)的诊断、治疗方法及医学鉴定现状。方法对93例临床有打鼾主诉的飞行人员进行多导睡眠监测,依据中华医学会呼吸病学分会睡眠呼吸疾病学组制定的阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)病情分度进行临床分组,比较不同组间年龄及体质量指数变化,比较手术及无创正压通气治疗前后睡眠呼吸暂停低通气指数的变化。结果 93例中单纯鼾症者所占比例最高,达35.5%;其次为轻度和重度OSAHS患者,分别为28.0%和23.7%。歼击机飞行员在各组中占比最高。鼾症组与轻度、重度OSAHS组间比较年龄有统计学差异(P<0.05)。单纯鼾症组、轻度OSAHS组与重度OSAHS组间比较体质量指数有统计学差异(P<0.01)。中、重度OSAHS组中18例(52.9%)进行了手术或无创正压通气治疗。6例飞行员给予飞行不合格结论,均为重度患者。手术治疗和无创正压通气治疗后患者呼吸暂停低通气指数均较治疗前明显降低(P<0.01),无创正压通气治疗优于手术治疗(t=4.275,P=0.000)。结论多导睡眠监测是诊断飞行人员阻塞性睡眠呼吸暂停低通气综合征的重要手段,无创正压通气治疗或合适的手术治疗均能使患者获益。Objective To analyze the diagnosis, treatment and medical identification of obstructive sleep apnea-hypopnea syndrome （OSAHS） in pilots. Methods The sleep status of 93 snoring pilots was analyzed by polysomnography. The pilots were divided into snoring group, mild OSAHS group and severe OSAHS group according to the diagnosis and treatment manual of OSAHS （2011 revised edition） by Sleep Apnea Disease Group, Chinese Society of Respiratory Disease, Chinese Medical Association. Their age and BMI were compared in different groups. Apnea-hypopnea index （AHI） were compared before and after treatment. Results Snoring, mild OSAHS and severe OSAHS pilots accounted for 35.5%, 28.0% and 23.7%, respectively, with the fighter pilots accounted for the highest percentage in all groups. The age was significantly younger in snoring group than in mild and sever OSAHS groups （P 〈 0.05）. The BMI was significantly lower in snoring group and mild OSAHS group than in sever OSAHS group （P 〈 0.01）. Eighteen pilots （52.9%） with moderate and sever, OSAHS underwent surgical or non-invasive continuous positive airway pressure （CPAP） treatment. Six severe OSAHS pilots were permanently grounded. The AHI was significantly lower after surgical operation or CPAP than before surgical operation or CPAP （P 〈 0.01）. The effect of CPAP was better than that of surgical operation （t=4.275, P=0.000）. Conclusion Polysomnography plays an important role in diagnosis of OSAHS in pilots. Both CPAP and surgical operation can improve OSAHS in pilots.

关 键 词：多导睡眠监测 阻塞性睡眠呼吸暂停低通气综合征 无创正压通气 飞行人员 

分 类 号：R856.5[医药卫生—航空、航天与航海医学]