快速动眼睡眠相关性阻塞性睡眠呼吸暂停事件的临床研究  

A preliminary clinical classification study in REM related obstructive sleep apnea

作　　者：蒋康伦[1] 赵琳[1] 李姝娜[1] 林志强[1] 马永明[1] Iqbal M A 钱炜[1] 

机构地区：[1]江苏大学附属人民医院耳鼻咽喉头颈外科,江苏镇江212002

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第10期744-748,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：江苏省六大人才高峰项目(No:2011-WSN021D);江苏省医学科研招标立项课题(No:H201353);镇江市科技支撑社会发展项目(No:SH2012042;SH2014045)

摘　　要：目的:探讨一种基于快速动眼睡眠期(REM)相关的阻塞性睡眠呼吸暂停事件(OSA)发生特征的分型方法及潜在临床意义。方法:250例OSA患者根据PSG分型:REM期相关组[RrOSA,REM期AHI与非REM期AHI(NREM-AHI)比值(R)>1,113例],非REM期相关组(NRrOSA,R≤1,137例);RrOSA组进一步分为RrOSAⅠ型(R≥2,34例)与RrOSAⅡ型(R>1,79例)。RrOSAⅠ型再根据非REM期AHI分为2个亚型:RrOASⅠa型(NREM_AHI<15,24例)与RrOSAⅠb型(NREM_AHI≥15,10例)。比较各分组PSG与临床数据。结果:RrOSA组患者AHI、ODI、NREM_AHI、NREM_ODI、REM期最大氧减、REM期最长氧减时间、NREM期最长氧减时间均显著低于NRrOSA组患者(均P<0.01)。REM期AHI或ODI 2组间无差异(P>0.05)。RrOSA各亚组之间REM期(AHI、ODI、最大氧减、最长氧减时间)、NREM期(AHI、ODI、最大氧减、最长氧减时间)均存在逐渐升高趋势。部分RrOSAⅠa组患者不耐受CPAP治疗,改用APAP治疗后效果满意。结论:对RrOSA进行进一步分组分析不同分期睡眠参数改变有助于了解OSA病程发生、发展。RrOSAⅠa分组对CPAP治疗模式选择可能存在指导意义。RrOSA可能是OSA患者中的一种特殊类型,这种类型可能随着病情严重而发展为其他类型。Objective：The aim of this study is to introduce a method in classifying the REM related OSA（RrO-SA） and the potential clinical significance. Method：Two hundred and fifty patients （male： 219） with OSAS diag- nosed by polysomnographywere recruited in the study. The RrOSAS was defined as the ratio of AHIs in REM and non REM sleep（R） greater than one. In RrOSAS group, patients were divided into RrOSAS I a（R〉2, NREM_AHI〈15）,RrOSAS Ib（R〉2, NREM_AHI〉15）, and RrOSASII （2〉R〉1） three subtypes. Parameters of PSG, ESS, BMI and neck circufernces were obtained for further analysis. In RrOSA I a group, the efficiencies of CPAP and AutoPAP were investigated. Result： ①There was a significant difference in gender between RrOSA and NRrOSA groups（P〈0. 05） ;②There was no significant differences in ESS and BMI among the three subtypes of RrOSA（P〉0.05） ; ③There was no significant difference in REM_AHI and REM_ODI between RrOSA and NR rOSA groups. Conclusion：The new method for the RrOSA classification helps better understanding the develop ment of OSAS and might be useful in planning the CPAP treatment. RrOSA may be a special type of OSA, which may develop into other types as the condition develops.

关 键 词：阻塞性睡眠呼吸暂停综合征 快速动眼睡眠 正压通气治疗 

分 类 号：R762[医药卫生—耳鼻咽喉科]