阻塞性睡眠呼吸暂停合并肥胖相关睡眠低通气的影响因素和预测指标分析  

Analysis of influencing factors and predictive indicators of obstructive sleep apnea combined with obesity-related sleep hypoventilation

作　　者：王乐[1] 陈杏 梁茂丽 张静[1] 王彦[1] 陈宝元[1] 曹洁[1] WANG Le;CHEN Xing;LIANG Maoli;ZHANG Jing;WANG Yan;CHEN Baoyuan;CAO Jie(Department of Respiratory and Critical Care Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院呼吸与危重症医学科,300052

出　　处：《天津医药》2022年第9期953-958,共6页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81670084,81970084)。

摘　　要：目的分析阻塞性睡眠呼吸暂停(OSA)合并肥胖相关睡眠低通气(ORSH)人群的临床特征和OSA合并ORSH的影响因素,探究预测OSA合并ORSH的指标。方法选取因打鼾就诊的肥胖[体质量指数(BMI)≥30 kg/m2]患者185例,所有患者均进行白天清醒状态下动脉血气分析、肺功能检查、不少于7 h的多导睡眠监测和经皮二氧化碳监测。根据上述检查结果,将患者分为单纯阻塞性睡眠呼吸暂停(OSA)组(109例)、OSA合并ORSH组(46例)和OSA合并肥胖低通气综合征(OHS)组(30例)。对比分析3组一般临床特征、肺功能、动脉血气以及多导睡眠监测指标,多因素Logistic回归分析OSA合并ORSH的影响因素,并建立模型,绘制受试者工作特征(ROC)曲线分析其预测效能。结果OSA合并OHS组腰围、BMI、脑卒中患者比例均高于单纯OSA和OSA合并ORSH组,而第1秒用力呼气容积占预计值百分比(FEV1%)和用力肺活量占预计值百分比(FVC%)显著低于单纯OSA和OSA合并ORSH组(P<0.05)。OSA合并OHS组的动脉血氧分压[p(O_(2))]显著低于单纯OSA组,而动脉血二氧化碳分压[p(CO_(2))]和碳酸氢根离子(HCO_(3)^(-))显著高于单纯OSA和OSA合并ORSH组(P<0.05);OSA合并ORSH组的p(CO_(2))和HCO_(3)^(-)显著高于单纯OSA组(P<0.05)。与单纯OSA组比较,OSA合并OHS组Epworth嗜睡量表评分(ESS)升高,OSA合并ORSH组和OSA合并OHS组的氧减指数(ODI)、呼吸暂停低通气指数(AHI)、微觉醒指数(MAI)、呼吸暂停指数(AI)、平均呼吸暂停时间(MAT)、最长呼吸暂停时间(LAT)、血氧饱和度小于0.90的时间占总时间的百分比(T90)和双水平气道正压通气(BI-PAP)模式治疗比例均升高,而最低血氧饱和度(minSpO_(2))和平均血氧饱和度(meanSpO_(2))均降低(P<0.05)。与OSA合并ORSH组比较,OSA合并OHS组持续气道正压通气(CPAP)模式治疗比例降低,BI-PAP模式呼吸机治疗比例升高(P<0.05)。多因素Logistic回归分析提示LAT延长和HCO_(3)^(-)升高是OSA合并ORSH的独�Objective To analyze the clinical characteristics and related influencing factors of obstructive sleep apnea(OSA)combined with obesity-related sleep hypoventilation(ORSH)and to identify indicators that can predict the OSA combined with ORSH population.Methods A total of 185 obese patients(body mass index≥30 kg/m^(2))who were admitted to hospital due to snoring were selected.All patients underwent daytime awake arterial blood gas analysis,pulmonary function examination,polysomnography monitoring and percutaneous carbon dioxide monitoring at least 7 hours.According to the above examination results,patients were divided into the OSA group(n=109),the OSA combined with ORSH group(n=46)and the OSA combined with obesity hypopnea syndrome(OHS)group(n=30).The general clinical characteristics,pulmonary function,arterial blood gas and polysomnography monitoring indexes were compared and analyzed in the three groups.Multivariate Logistic regression analysis was conducted to analyze the risk factors of OSA combined with ORSH.A model was established and receiver operating characteristic(ROC)curve was drawn to analyze the prediction efficiency.Results Waist circumference,BMI and proportion of stroke patients were higher in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group,while the percentage of forced expiratory volume in the first second in the predicted value(FEV1%)and the percentage of forced vital capacity in the predicted value(FVC%)were significantly lower in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group(P<0.05).Arterial partial pressure of oxygen[p(O_(2))]was significantly lower in the OSA combined with OHS group than that in the OSA group,while arterial partial pressure of carbon dioxide[p(CO_(2))]and bicarbonate ion(HCO_(3)^(-))were significantly higher than those in the OSA group and the OSA combined with ORSH group(P<0.05).P(CO_(2))and HCO_(3)^(-)were significantly higher in the OSA combined with ORSH group than those

关 键 词：肥胖低通气综合征 睡眠呼吸暂停综合征 高碳酸血症 二氧化碳 血气分析 最长呼吸暂停时间 

分 类 号：R563.9[医药卫生—呼吸系统]