吸烟与阻塞性睡眠呼吸暂停的相关性分析  

Correlation analysis between smoking and obstructive sleep apnea

作　　者：李雨凝 刘雪 冯晓瑜 安金路 史江[1] 蒋军广[1] LI Yuning;LIU Xue;FENG Xiaoyu;AN Jinlu;SHI Jiang;JIANG Junguang(Elderly Respiratory Sleep Department,The First Affiliated Hospital of Zhengzhou University,Henan Institute of Respiratory Disease,Zhengzhou,Henan 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院河南省呼吸疾病研究所老年呼吸睡眠科,河南郑州450052

出　　处：《中国呼吸与危重监护杂志》2023年第4期251-255,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544号)。

摘　　要：目的研究吸烟与阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的相关性。方法回顾性收集2015年10月—2021年7月间因睡眠问题就诊的454例患者,行夜间多导睡眠监测(均不少于7 h)。根据多导睡眠监测结果,将患者分为OSA组(405例)和对照组(单纯鼾症患者49例)。参考呼吸暂停低通气指数(apnea-hypopnea index,AHI)及睡眠期间最低血氧饱和度对OSA的严重程度进行分度,分为轻中度组(5次/h≤AHI<30次/h)和重度组(AHI≥30次/h)。详细询问并记录吸烟史,将诊断为OSA的患者根据其吸烟史再分为吸烟组、已戒烟组、不吸烟组。结果OSA组患者吸烟率高于对照组(50.9%比32.7%,P<0.05),重度OSA组的患者吸烟率高于轻中度组(55.7%比39.8%,P<0.05)。吸烟与AHI、血氧饱和度低于90%时间占总睡眠时间百分比(cumulative percentages of time spent at oxygen saturation below 90%,Ts90%)、总呼吸暂停时间呈正相关(r值分别为0.196、0.197、0.163,P<0.05),与睡眠期间最低脉搏血氧饱和度(SpO2)、平均SpO2呈负相关(r值分别为–0.202、–0.214,P<0.05)。以重度OSA为结局变量的Logistic回归分析结果显示吸烟[比值比(odds ratio,OR)=1.781]、肥胖(OR=1.930)是重度OSA的独立危险因素(P<0.05)。OSA患者不同吸烟状态组间对比,吸烟组重度OSA所占比例、AHI、Ts90%、总呼吸暂停时间(分别为77.8%、53.55次/h、18.35%、111.70 min)均大于不吸烟组(分别为62.8%、40.20次/h、8.40%、76.20 min,P<0.05),睡眠期间最低SpO2、平均SpO2(分别为69.50%、93.00%)均小于不吸烟组(分别为75.00%、94.00%,P<0.05);已戒烟组平均SpO2高于吸烟组(94.00%比93.00%),Ts90%小于吸烟组(6.75%比18.35%),差异均有统计学意义(P<0.05)。结论吸烟明显影响睡眠呼吸障碍程度,吸烟可能是重度OSA的独立危险因素。吸烟可加重OSA严重程度及缺氧程度,戒烟可改善OSA患者缺氧程度。Objective To study the correlation between smoking and obstructive sleep apnea(OSA).Methods A total of 454 patients from October 2015 to July 2021 were retrospectively collected for nocturnal polysomnography monitoring(no less than 7 hours).The patients were divided into an OSA group(n=405)and a control group(n=49,patients with primary snoring)according to the results of polysomnography monitoring.According to the apnea hypopnea index(AHI)and the lowest oxygen saturation during sleep,the severity of OSA was classified into a mild to moderate group(5 times/h≤AHI<30 times/h)and a severe group(AHI≥30 times/h).The patients were inquired about their smoking history,then the patients diagnosed with OSA were further divided into a smoking group,a smoking cessation group,and a non-smoking group based on their smoking history.Results The smoking rate of the patients in the OSA group was higher than that in the control group(50.9%vs.32.7%,P<0.05),while the smoking rate in the severe OSA group was higher than that in the mild to moderate group(55.7%vs.39.8%,P<0.05).Smoking was positively correlated with AHI,cumulative percentages of time spent at oxygen saturation below 90%(Ts90%),and total apnea time(r value was 0.196,0.197,0.163,P<0.05),while negatively correlated with the lowest and average SpO2 during sleep(r value was–0.202,–0.214,P<0.05).The logistic regression analysis with severe OSA as the outcome variable showed that smoking(OR=1.781)and obesity(OR=1.930)were independent risk factors of severe OSA(P<0.05).The comparison between groups of the OSA patients with different smoking states showed that the proportion of severe OSA,AHI,Ts90%,and total apnea time(77.8%,53.55 times/h,18.35%,and 111.70 minutes,respectively)of the smoking group were higher than those of the non-smoking group(62.8%,40.20 times/h,8.40%,and 76.20 minutes,respectively,P<0.05).The lowest SpO2 and average SpO2 during sleep(69.50%,93.00%,respectively)of the smoking group were lower than those of the non-smoking group(75.00%,94.00%,respective

关 键 词：吸烟 阻塞性睡眠呼吸暂停 戒烟 缺氧程度 

分 类 号：R766[医药卫生—耳鼻咽喉科]