上气道持续正压通气治疗对阻塞性睡眠呼吸暂停综合征患者睡眠结构的影响  

The effect of continuous positive airway pressure treatment on sleep architecture in patients with obstructive sleep apnea syndrome

作　　者：丁秀[1] 王小轶[1] 罗巍[2] 袁世针 王晓晔[3] DING Xiu;WANG Xiaoyi;LUO Wei;YUAN Shizhen;WANG Xiaoye(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China;Chinese Center for Disease Control And Prevertion,Beijing,102206,China;Department of Otolaryngology Head and Neck Surgery,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Changzhou,Jiangsu,213000,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]中国疾病预防控制中心,北京102206 [3]苏州大学附属第三医院,常州市第一人民医院耳鼻咽喉头颈外科,江苏常州213000

出　　处：《中国耳鼻咽喉头颈外科》2023年第3期181-185,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金项目(81773505)。

摘　　要：目的定量探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者接受上气道持续正压通气(CPAP)治疗前后睡眠结构的变化。方法对2018年7月~2020年6月以睡眠打鼾为主要症状就诊于北京同仁医院,经整夜多导睡眠监测(PSG)诊断为OSAS的成年患者,完成人体学特征采集,并在1个月内再次于我院睡眠监测中心接受标准整夜人工压力滴定。根据呼吸暂停低通气指数(AHI)将患者进行分组:轻中度组(AHI≤30次/h),重度组(30次/h60次/h),比较各组间临床特征、睡眠结构,比较CPAP治疗前后睡眠结构的差异。结果共纳入93例患者,男82例(88.2%,82/93),女11例(11.8%,11/93),年龄18~80(44.3±13.8)岁,体质量指数(BMI)21.8~43.8(30.5±4.8)kg/m2,AHI 11.0~130.8(70.7±24.2)次/h。轻中度组6例(6.5%,6/93),重度组22例(23.7%,22/93),极重度组65例(69.9%,65/93),三组间觉醒指数(AI)分别为(8.3±4.7)次/h、(24.3±15.3)次/h、(54.8±25.7)次/h,组间比较差异有统计学意义(F=18.785,P=0.000);三期睡眠占总睡眠时间百分比(N3期)分别为(3.1±3.4)%、(2.7±5.6)%、(0.2±0.5)%,组间比较差异有统计学意义(F=8.530,P=0.000)。CPAP治疗前和治疗后,AI分别为(45.3±27.8)次/h、(2.4±2.7)次/h,差异有统计学意义(t=13.990,P=0.000),一期睡眠占总睡眠时间百分比(N1期)分别为(18.7±15.0)%、(8.6±5.1)%,差异有统计学意义(t=6.201,P=0.000),二期睡眠占总睡眠时间百分比(N2期)分别为(62.4±13.1)%、(58.2±10.1)%,差异有统计学意义(t=2.599,P=0.011),N3期分别为(0.94±3.1)%、(6.4±9.1)%,差异有统计学意义(t=-5.548,P=0.000)、快速动眼期占总睡眠时间百分比(REM期)分别为(18.0±6.8)%、(26.8±8.7)%,差异有统计学意义(t=-8.283,P=0.000)。结论OSAS患者经过CPAP治疗,能够增加深睡眠、明显改善睡眠结构。OBJECTIVE To study the changes of sleep architecture before and after continuous positive airway pressure(CPAP)therapy in patients with obstructive sleep apnea syndrome(OSAS).METHODS Adult OSAS patients who visited Beijing Tongren Hospital from Jul 2018 to Jun 2020 were treated with CPAP were included in this study.Patients were divided into three groups according to their apnea hypopnea index(AHI)results:Mild-moderate group,AHI≤30 times/h;Severe group,30 times/hAHI≤60 times/h;Extremely severe group,AHI60 times/h.RESULTS A total of 93 patients were included in this study with 82 males(88.2%)and 11 females(11.8%).Mean age was(70.7±13.8)years,and the mean body mass index was(30.5±4.8)kg/m^(2);AHI ranged between 11.0 and 130.8/h with a mean of(70.7±24.2)times/h.There were 6(6.5%),22(23.7%),and 65(69.9%)patients in mild-moderate group,severe group,and extremely severe group,respectively.There were significant differences for arousal index[(8.3±4.7)times/h,(24.3±15.3)times/h,(54.8±25.7)times/h,F=18.785,P=0.000)]and N_(3)sleep stage percent[(3.1±3.4)%,(2.7±5.6)%,(0.2±0.5)%,F=8.530,P=0.000)]among three groups.Patients with OSAS treated with CPAP had significant improvement across several sleep architecture parameters.Arousal index decreased from(45.3±27.8)times/h to(2.4±2.7)times/h(t=13.990,P=0.000),N_(1)sleep stage percent decreased from 18.7%±15.0%to8.6%±5.1%(t=6.201,P=0.000),N_(2)sleep stage percent decreased from(62.4±13.1)%to(58.2±10.1)%(t=2.599,P=0.011),N_(3)sleep stage percent increased from(0.94±3.1)%to(6.4±9.1)%(t=-5.548,P=0.000),and REM sleep stage percent increased from(18.0±6.8)%to(26.8±8.7)%(t=-8.283,P=0.000).CONCLUSION There was significant improvement across several sleep architecture parameters among patients who responded successfully to CPAP.

关 键 词：睡眠呼吸暂停 阻塞性 上气道持续正压通气治疗 睡眠结构 睡眠分期 

分 类 号：R766[医药卫生—耳鼻咽喉科]