阻塞性睡眠呼吸暂停低通气综合征患者冷热试验特征分析  

Feature of semicircular canal function in obstructive sleep apnea-hypopnea syndrome

作　　者：韩曦[1] 鲁宏华[2] 陈太生[3] 徐开旭[3] 林鹏[3] 温超[3] 李前伟[3] 程岩[3] 王巍[3] 

机构地区：[1]天津医科大学一中心临床学院,300192 [2]天津市耳鼻喉科研究所 [3]天津市第一中心医院耳鼻咽喉头颈外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第6期482-487,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：天津市卫计委攻关项目（10KG219）

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对患者内耳半规管功能的影响。方法对2012年10月至2014年8月收治的77例OSAHS患者进行冷热试验和多道睡眠监测（polysomnography，PSG）。其中男67例，女10例；年龄21-57岁，平均37．8岁；病程6个月～25年，平均8．2年。以双耳冷热刺激诱发眼震慢相速度（slow phase velocity，SPV）值、单侧半规管反应减退（Unilateral weakness，uw）值，PSG最低动脉血氧饱和度（LSaO：）及呼吸暂停低通气指数（apnea hypopnea index，AHI）等为评定指标，分析OSAHS患者冷热试验的结果特征及其与LSaO2、AHI等的关系。结果77例OSAHS患者冷热试验结果正常者25例（32．5％），异常52例（67．5％），其中单侧异常16例（20．8％），双侧异常36例（46．7％）。对冷热刺激反应强侧耳的冷、热刺激SPV总和与LSaO2进行回归分析，二者存在线性关系（P〈0．05），相关性分析，二者呈正相关（r=0．283，P〈0．05）。按照不同LSaO，将OSAHS患者分为五组，对各组患者反应强侧耳冷、热刺激SPV总和进行单因素方差分析，LSaO，〈50％组与LSaO，〉180％组患者的反应强侧耳SPV总和差异具有统计学意义（F=3．155，P〈0．05）。按冷热试验不同结果将OSAHS患者进行分组，单因素方差分析各组LSaO2值，冷热试验结果正常组与双侧异常组间差异有统计学意义（F=4．892，P〈0．05）；正常组与单侧异常组之间、单侧异常组与双侧异常组间LSaO，差异无统计学意义（均P〉0．05）。结论OSAHS患者长期间断缺氧可能累及内耳前庭器官导致半规管功能减退，但尚未出现眩晕和平衡障碍等急性前庭损伤的典型症状。Objective The aim of this study was to evaluate the effects of obstructive sleep apnea- hypopnea syndrome （OSAHS） on semicircular canal function. Methods By means of a series prospective study at Department of Otolaryngology Head and Neck Surgery of our hospital, the study was performed on 77 patients suffering from OSAHS in a period from 2012 to 2014, who underwent polysomnography（PSG） and calorie test. The maximal slow-phase velocity （SPV） and unilateral weakness （UW） were used to measure the vestibular function. Severity of OSAHS was evaluated by the lowest oxygen saturation（ LSaO2 ） and apnea hypopnea index（AHI）. The SPV after cool was signed, warm test was performed for each ear, and the sum of left ear SPV were calculated, and then, the SPV of right ear was counted as the same way. Finally, the relationships between LSaO2, AHI, age, BMI, and SPY of caloric test were analyzed. Results Caloric vestibular tests in the 77 OSAHS patients demonstrated abnormal findings in 52 patients （67.5 % ） and normal vestibular functions in the remaining 25 patients（ 32. 5% ）. Of the 52 patients with an abnormal test result,16（20. 8% ）patients had unilateral vestibular hyporeflexia and 36 （46. 7% ）patients revealed a bilateral vestibular hyporeflexia. There was no linear relationship between AHI, age, BMI with SPV of caloric test （P 〉0. 05 ）. The SPV had significant difference between Lower LSaO2 group （LSaO2 〈 50% ） and higher LSaO2 group （ LSaO2 ≥ 80% ） （ P 〈 O. 05 ）. LSaO2 was lower in patients undertaken bilateral vestibular hyporeflexia. Conclusions OSAHS patients with long-term intermittent hypoxia can disturb the vestibular organs and reduce semicircular canal function. The heavier hypoxemia will lead to the lower reflex of semicircular canal, with the heavier degree of hypoxemia, and the bilateral horizontal semicircular canal involvement may also be higher at the same time. Due to the effect of vestibule centre compensatory, OSAHS patients lack of dizzin

关 键 词：睡眠呼吸暂停 阻塞性 前庭 迷路 冷热试验 多道睡眠描记术 

分 类 号：R766[医药卫生—耳鼻咽喉科]