血氧饱和度近似熵和血氧受损时间指数评估阻塞性睡眠呼吸暂停低通气综合征患者低氧程度的研究  

Approximate entropy of oxygen saturation and saturation impairment time index for the assessment of hypoxemia severity in obstructive sleep apnea hypopnea syndrome

作　　者：刘杰[1] 肖毅[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院健康医学部,100730 [2]中国医学科学院北京协和医学院北京协和医院呼吸内科,100730

出　　处：《中华内科杂志》2014年第8期607-610,共4页Chinese Journal of Internal Medicine

基　　金：国家“十二五”科技支撑计划

摘　　要：目的 分析血氧饱和度近似熵（SpO2ApEn）和血氧受损时间指数（SITi）评估阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者睡眠期间低氧严重程度的意义,评价其临床价值.方法 以睡眠呼吸暂停低通气指数（AHI）为标准将500例疑诊OSAHS患者分为正常对照组（113例）、轻度OSAHS组（121例）、中度OSAHS组（118例）、重度OSAHS组（148例）,监测睡眠中最低脉搏血氧饱和度（LSpO2）、氧减指数（ODI）、血氧饱和度＜90％占整个记录时间的百分比（T＜90％）及SpO2 ApEn、SITi,并进行相关性分析.采用ROC曲线分析及约登指数明确SpO2 ApEn、SITi对评估OSAHS低氧程度的意义.结果 SpO2ApEn正常对照组为13.5±2.8,轻度OSAHS组为15.8±2.6,中度OSAHS组为19.0±3.4,重度OSAHS组为23.8±5.7; SITi正常对照组为2.9±1.2,轻度OSAHS组为3.5±1.3,中度OSAHS组为4.3±1.5,重度OSAHS组为6.7±2.7;组间比较差异均有统计学意义（P值均＜0.001）.相关性分析：ODI与AHI有相关性（r=0.967 P＜0.01）,SpO2ApEn与AHI、ODI、LSpO2、T＜90％有相关性（r分别为0.765、0.808、-0.557、0.623,P值均＜0.01）,SITi与AHI、ODI、LSpO2、T＜90％有相关性（r分别为0.678、0.755、-0.768、0.878,P值均＜0.01）.根据ROC曲线分析结果,SpO2 ApEn值为16.70、17.81、20.03可作为判断OSAHS患者轻度、中度、重度低氧的界值,SITi值为3.685、4.055、4.445.结论 随OSAHS病情加重SpO2 ApEn、SITi明显增高,与AHI、ODI、LSpO2T＜90％存在一定的相关性,SpO2ApEn、SITi对评价OSAHS低氧严重程度具有临床价值.Objective To explore the clinical significance of two new indexes including approximate entropy of oxygen saturation （SpO2ApEn） and saturation impairment time index （SITi） in assessing the severity of hypoxemia in obstructive sleep apnea hypopnea syndrome （OSAHS） patients.In addition,to investigate the correlation betewwn new indexes and other parameters.Methods The six hour polysomnography （PSG） of 500 patients with OSAHS and snorers in our hospital was retrospectively analyzed.According to the level of apnea hypopnea index （AHI）,subjects were divided into four subgroups,namely 113 healthy controls,121 mild OSAHS,118 moderate OSAHS,and 148 severe OSAHA patients.SpO2 ApEn and SITi values among the four groups were compared.the correlations between SpO2 ApEn,SITi and other parameters were analyzed,including AHI,oxygen desaturation index （ODI）,the lowest oxygen saturation（LSpO2） and the duration of oxygen saturation lower than 90％ （T ＜ 90％）.Next,taking AHI as the gold standard,the significance of SpO2ApEn and SITi in assessing the severity of hypoxemia in OSAHS patients was explored by ROC curve analysis.Results SpO2ApEn and SITi between two each groups were significantly different （P ＜ 0.001） and increased synchronously with AHI.Spearman correlation analysis showed that SpO2ApEn and SITi had a good correlation with AHI （correlation coefficient r =0.765,r =0.678,P ＜ 0.O1）.SpO2ApEn and SITi also had a good correlation with ODI,LSpO2and T ＜ 90％.According to the ROC analysis,the Boundary values of SpO2ApEn for mild,moderate and severe OSAHS patients were 16.70,17.81,and 20.03,respectively,and the corresponding SITi values were 3.685,4.055,and 4.445.Conclusion In this study,SpO2ApEn and SITi increased synchronously with AHI,SpO2ApEn and SITi had good correlations with AHI,ODI,LSpO2and T ＜90％.SpO2ApEn and SITi have important clinical significance for assessment of hypoxia severity in OSAHS patients.

关 键 词：睡眠呼吸暂停 阻塞性 睡眠呼吸暂停低通气指数 血氧饱和度近似熵 血氧受损时间指数 

分 类 号：R766[医药卫生—耳鼻咽喉科]