混合型睡眠呼吸暂停与治疗后中枢性睡眠呼吸暂停的关系  

Association between mixed sleep apnea and treatment-emergent central sleep apnea

作　　者：雷飞[1] 谭璐[1] 李桃美 任蓉[1] 周俊英[1] 周新雨[2] 唐向东[1] 杨玲慧[3] Lei Fei;Tan Lu;Li Taomei;Ren Rong;Zhou Junying;Zhou Xinyu;Tang Xiangdong;Yang Linghui(Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu 610041;department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China;Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital,Sichuan University, Chengdu 610041,China)

机构地区：[1]四川大学华西医院睡眠医学中心,成都610041 [2]重庆医科大学附属第一医院精神科,重庆40001 [3]四川大学华西医院麻醉与危重急救研究室转化神经科学中心,成都610041

出　　处：《中华医学杂志》2019年第24期1864-1869,共6页National Medical Journal of China

基　　金：国家自然科学基金(81530002.81629002,81770087).

摘　　要：目的探讨混合型睡眠呼吸暂停(MA)与治疗后中枢性睡眠呼吸暂停(TE-CSA)的关系。方法回顾性分析2013年8月至2018年11月经整夜多导睡眠监测(PSG)确诊为中重度阻塞性睡眠呼吸暂停(OSA)且接受持续气道正压通气(CPAP)治疗的256例患者的临床和PSG资料。根据基线非快速眼球运动(NREM)睡眠期和快速眼球运动(REM)睡眠期的混合型呼吸暂停指数(MAI)和呼吸暂停低通气指数(AH1),将所有患者分为A组(MAI=0次/h)、B组(NREM-MAI25次/h且REM-MAK5 次/h)和 C 组(REM-MAIP5 次/h且 NREM-MAK5 次/h),三组各 110,72 和74 例;进一步分析比较三组患者CPAP治疗前后睡眠呼吸相关参数以及TE-CSA发生率的差异。结果B组和C组AHI[66.6(56.O,81.7)和79.8(63.6,8&3)次/h]、REM-AHI[60.1 (49.1,70.0)和66.3(56.1,74.6)次/h]、NREM-AHI[67.6(53.7,82.4)和 81.3(64.2,91.5)次Zh]均显著高于 A 组[44.2(26.8,64.5)、50.0(34.7,64.7)、43.5 (25.9,65.1)次/h](均 P<0.05)。B 组和 C 组平均血氧饱和度[(90.8%±3.6%)和(87.3%±5.1%)]、最低血氧饱和度[(61.0%±16.0%)和(47.9%±17.0%)]均显著低于 A 组[(92.6%±3.5%)、(70.6%±14.1%)](均P<0.05)。所有患者TE-CSA发生率为7.8%,B组发生率(14.1%)均显著高于A组(2.7%)和C组(4.1%)(均P<0.05),但是A组和C组差异无统计学意义。结论TE-CSA与基线MA相关,基线NREM睡眠期的M A可以预测首次CPAP治疗后TE-CSA的发生率。Objective To examine the association between mixed sleep apnea (MA) and treatment-emergent central sleep apnea (TE-CSA). Methods A total of 256 patients meeting the diagnostic criteria of moderate to severe obstructive sleep apnea (OSA) based on overnight polysomnography (PSG) and receiving continuous positive airway pressure (CPAP) therapy in West China Hospital, Sichuan University during the period from August 2013 to November 2018 were enrolled in the study. Based on the mixed apnea index (MAI) and apnea-hypopnea index (AHI) in the baseline PSG study during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, the subjects were categorized into three groups of A (MAI=0/h, n=110), B (NREM?MAI$5/h and REM?MAIv5/h, n=72) and C (REM-MAI^5/h and NREM-MAK 5/h, n=74). Sleep and breathing related parameters before and after CPAP therapy among three groups and the difference of TE-CSA incidence were analyzed. Results The AHI [(44.2(26.8,64.5)/h,66.6(56.0,81.7)/h, 79.8(63.6, 88.3)/h], REM-AHI [50.0(34.7, 64.7)/h, 60.1(49.1, 70.0)/h, 66.3(56.1, 74.6)/h] and NREM-AHI [43.5(25.9, 65. l)/h,67.6(53.7, 82.4)/h,81.3(64.2, 91.5)/h]) were higher in group B and C compared to group A (all P<0.05),while the mean and lowest oxygen saturation [(92.6%±3.5%),(90.8%±3.6%),(87.3%±5.1%) and (70.6%±14.1%),(61.0%±16.0%),(47.9%±17.0%)] were lower in group B and group C compared to group A (all P<0.05). The incidence of TE-CSA after initial CPAP was 7.8% in all patients, and the incidence was significantly higher in group B of 14.1% compared to group C of 4.1% and group A of 2.7%(all P<0.05). Conclusions TE-CSA is correlated with baseline MA,and baseline MA in NREM sleep can predict the incidence of TE-CSA after initial CPAP.

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

分 类 号：R766[医药卫生—耳鼻咽喉科]