首次CPAP压力滴定对有和无日间嗜睡OSAHS患者的治疗效果差异及分析  

Different effect and analysis of the first CPAP pressure titration in OSAHS patients with/without daytime sleepiness

作　　者：秦丽霞 陆巧[2] 李哲 QIN Li-xia;LU Qiao;LI Zhe(Medical Administration Department,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital,Chengdu,Sichuan 610072,China;Department of Psychosomatic Medicine Center,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital,Chengdu,Sichuan 610072,China;Department of Psychiatry,Panzhihua Shengtai Rehabilitation Hospital,Panzhihua,Sichuan 617000,China)

机构地区：[1]四川省医学科学院·四川省人民医院医务部,四川成都610072 [2]四川省医学科学院·四川省人民医院心身医学中心,四川成都610072 [3]攀枝花盛泰康复医院精神科,四川攀枝花617000

出　　处：《临床肺科杂志》2023年第4期584-589,共6页Journal of Clinical Pulmonary Medicine

基　　金：国家自然科学基金(No.81500072)。

摘　　要：目的探讨首次持续气道正压通气(CPAP)压力滴定对有和无日间嗜睡症状的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间睡眠结构及主观睡眠感受的治疗效果。方法纳入经整夜多导睡眠图监测确诊的中-重度OSAHS患者[呼吸暂停低通气指数(AHI)≥15次/h]136例。首次平均睡眠潜伏期(MSL)<10 min定义为嗜睡组,MSL≥10 min为无嗜睡组。结果与嗜睡组相比,无嗜睡组年龄大[(45.7±12.2)岁vs.(56.9±12.7)岁],CPAP治疗前睡眠潜伏期长[4.0(1.6,7.0)min vs.8.5(5.1,16.0)min],总睡眠时间短[471.8(455.4,496.8)min vs.441.5(394.2,475.5)min](均P<0.05)。两组间体质指数、腰臀比、共病率(高血压、冠心病、糖尿病)差异无统计学意义。经首次CPAP压力滴定治疗后,两组患者AHI降低,1期睡眠减少,快动眼睡眠期、3期睡眠增加,最低和平均血氧饱和度升高(均P<0.05);嗜睡组MSL延长,无嗜睡组主观入睡后觉醒次数减少(P<0.05);CPAP治疗前后差值相比,嗜睡组1期和2期睡眠、AHI和血氧饱和度较无嗜睡组改善有统计学差异。结论经过首次CPAP压力滴定治疗,有和无嗜睡OSAHS严重程度均降低,睡眠质量提高,主观睡眠连续性显著改善。嗜睡OSAHS患者日间嗜睡改善,睡眠知觉提高,睡眠质量及OSAHS严重程度较无嗜睡患者改善更为显著。有和无日间嗜睡的OSAHS患者首次CPAP滴定治疗有效。Objective To investigate the effect of the first continuous positive airway pressure(CPAP)titration on sleep structure,and subjective sleepiness in obstructive sleep apnea hypopnea syndrome(OSAHS)patients with/without daytime sleepiness.Methods A total of 78 patients with overnight polysomnography determined moderate-to-severe OSAHS[Apnea hypopnea index(AHI)≥15 times/h],were enrolled in the study.The sleepy group was considered present whenever initial multiple sleep latency(MSL)<10 minutes.The non-sleepy group was determined in patients with MSL≥10 minutes.Results Compared with the non-sleepy group,the sleepy group showed older age[(45.7±12.2)y vs.(56.9±12.7)y],longer sleep latency[4.0(1.6,7.0)min vs.8.5(5.1,16.0)min]and shortened total sleep time[471.8(455.4,496.8)min vs.441.5(394.2,475.5)min](all P<0.05).There was no significant difference in body mass index,waist-hip ratio or co-morbidity(hypertension,coronary artery disease,and diabetes)between the two groups.CPAP titration decreased AHI and duration of stage 1 sleep,increased duration of REM sleep and stage 3 sleep,raised the lowest and mean oxygen saturation of OSAHS patients(all P<0.05).Furthermore,CPAP titration increased MSL of sleepy patients,but decreased subjective awakening time of non-sleepy patients(P<0.05).Compared with the non-sleepy group,there were statistical differences in duration of stage 1 and 2 sleep,AHI,and blood oxygen saturation in the sleepy group.Conclusion The first CPAP titration decreases the severity of OSAHS and increases sleep quality immediately,and improves subjective sleep continuity of sleepy and non-sleepy patients significantly.The excessive daytime sleepiness is decreased,and sleep perception is improved in sleepiness patients,and sleep quality and OSAHS severity are significantly improved.These results confirm the effect of first CPAP titration in OSAHS patients with/without daytime sleepiness.

关 键 词：阻塞性睡眠呼吸暂停 持续气道正压通气 日间过度嗜睡 日间多次睡眠潜伏期试验 

分 类 号：R766[医药卫生—耳鼻咽喉科]