高原地区OSAS患者CPAP治疗后中枢性睡眠呼吸暂停的发生率及影响因素  

Incidence and influencing factors of continuous positive airway pressure treatment-emergent central sleep apnea in the patients with obstructive sleep apnea syndrome at high altitude

作　　者：苗志斌[1] 王耶盈[2] 孙睿[1] 雷红丽[1] 黄代金 黄李华[1] 樊重阳 吕云辉[1] 

机构地区：[1]昆明理工大学附属云南省第一人民医院睡眠医学中心,650504 [2]昆明医科大学公共卫生学院流行病学与卫生统计学系

出　　处：《中华医学杂志》2017年第12期915-919,共5页National Medical Journal of China

基　　金：国家自然科学基金（81460017）

摘　　要：目的调查高原地区阻塞性睡眠呼吸暂停综合征（OSAS）患者初次给予持续气道正压通气（CPAP）后治疗相关的中枢性睡眠呼吸暂停（TE－CSA）的发生率，并分析其人群特征和影响因素。方法回顾分析2015年1—12月来自高原地区（海拔≥1 000 m）并在云南省第一人民医院睡眠医学中心诊断为OSAS的297例成年患者的临床资料，患者均进行了整夜CPAP治疗。根据治疗后是否发生TE－CSA将患者分为TE－CSA组和非TE－CSA组，比较两组的一般资料、居住地海拔、多导睡眠监测及压力滴定参数、肺功能、血气分析等临床数据并进行统计学分析。结果高原地区OSAS患者初次压力滴定时TE－CSA的发生率为16.5%（49/297）。其中男性发生率高于女性（18.2%比6.8%，P＝0.061）；随着年龄、体质指数（BMI）增加和居住地海拔下降，发生率呈下降趋势。多因素Logistic回归分析显示，居住地海拔高度、混合性呼吸暂停指数（MAI）、第一秒用力呼气容积（FEV1）/用力肺活量（FVC）比值、肺残气量（RV）/肺总量（TLC）比值是影响TE－CSA发生的主要因素，其中居住地海拔高度、MAI增加是危险因素[OR＝1.16（1.02，1.32）、1.05（1.01，1.09）]；FEV1/FVC、RV/TLC升高则是保护因素[OR＝0.94（0.89，0.98）、0.94（0.88，0.99）]。结论高原地区TE－CSA的发生率较高，居住地海拔和MAI增高是其发生的危险因素。Objective To investigate the incidence of treatment-emergent central sleep apnea （TE- CSA）, the characteristics of demography and the influencing factors in patients with obstructive sleep apnea syndrome （OSAS） after initial continuous positive airway pressure （CPAP） titration at high altitude. Methods Clinical data of 297 patients with OSAS which living in plateau areas （ 1 000 meters or more above sea level） were retrospectively analyzed in this study from January to December, 2015. All of these patients taken an overnight CPAP titration in the Sleep Medicine Center of First People＇s Hospital of Yunnan Province. They were classified as with TE-CSA group and non TE-CSA group according to the outcome of CPAP titration. Comparisons of demographic characteristic, parameters of polysomnography in CPAP titration night, lung function test and blood gas analysis were made between the two groups, respectively, and statistical analysis was carried. Results The incidence of TE-CSA was 16. 5% （49/297） after initial CPAP titration at high altitude, which was higher in male patients （ 18. 2% vs 6. 8%, P = 0. 061 ）. The incidence of TE-CSA decreased with the increase of age and body mass index （ BMI）, and the decrease of resident altitude. Multivariate Logistic regression analysis showed that the resident altitude, mixed apnea index （MAI）, forced expiratory volume in 1 second （FEV1） and forced vital capacity （FVC） ratio, functional residual capacity （RV） and total lung capacity （TLC） ratio were the main factors affecting the occurrence of TE-CSA. Among them, the increase of resident altitude and MAI were risk factors [ OR = 1.16 （1.02, 1.32）, 1.05 （1.01, 1.09）]. The increase of FEV1/FVC and RV/TLC were protective factors [ OR = 0. 94 （0. 89, 0. 98）, 0. 94 （0. 88, 0. 99） 1- Conclusion The incidence of TE-CSA is high at high altitude area, and the increase of resident altitude and MAI are the risk factors for TE-CSA.

关 键 词：睡眠呼吸暂停 阻塞性 睡眠呼吸暂停 中枢性 连续气道正压通气 治疗 结果 

分 类 号：R766[医药卫生—耳鼻咽喉科]