呼吸事件持续时间在成年人阻塞性睡眠呼吸暂停夜间低氧血症中的意义  

Significance of Duration of Respiratory Events in Nocturnal Hypoxemia in Adults with Obstructive Sleep Apnea

作　　者：王剑英[1] 任寿安[2] WANG Jianying;REN Shouan(Shanxi Medical University,Taiyuan 030000,China;Department of Respiratory and Critical Care Medicine,First Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学,山西省太原市030000 [2]山西医科大学第一医院呼吸与危重症医学科,山西省太原市030000

出　　处：《中国全科医学》2024年第14期1699-1707,共9页Chinese General Practice

摘　　要：背景阻塞性睡眠呼吸暂停(OSA)患病率逐年升高,但目前OSA普遍使用呼吸暂停低通气指数(AHI)>5次/h的诊断标准对疾病的诊断、评估病情的严重程度、治疗效果以及远期并发症的预测中逐渐暴露出弊端,本研究提出评估OSA的参数除了AHI外,还需纳入更多关于呼吸暂停低通气时间的信息。目的探讨呼吸事件持续时间在成年人阻塞性睡眠呼吸暂停夜间低氧血症中的意义。方法选取2021年10月—2022年3月就诊于山西医科大学第一医院睡眠监测室疑诊为OSA的患者296例作为研究对象。在进行多导睡眠监测(PSG)前,受试者均接受了身高、体质量、颈围等方面的体格检查,并详细询问了其睡眠史以及高血压及糖尿病史等信息。根据AHI将受试者分为3组:5次/h≤AHI<15次/h为轻度OSA组(56例),15次/h≤AHI<30次/h为中度OSA组(62例),AHI≥30次/h为重度OSA组(178例)。比较3组血氧指标[最低血氧饱和度(LSpO_(2))、平均血氧饱和度(MSpO_(2))、基线血氧饱和度(BSpO_(2))、氧减指数(ODI)及血氧饱和度(SpO_(2))<90%的时间占整夜总睡眠时间的百分比(T90)]和呼吸事件持续时间参数[平均呼吸暂停持续时间(MTAD)、平均呼吸低通气持续时间(MHD)、平均呼吸暂停-低通气持续时间(MAD)、总呼吸暂停时间最长值(LTAD)、最长低通气时间(LHD)、最长呼吸暂停-低通气持续时间(LAD)、总呼吸暂停-低通气持续时间(TAD)、AHI、呼吸暂停-低通气持续时间占总睡眠时间百分比(AHT%)]的差异,采用Spearman秩相关分析探讨呼吸事件持续时间参数与血氧指标的相关性。根据TAD和AHT%的中位数(分别为69.78 min和14.33%),将OSA患者分为短事件组(短TAD亚组、短AHT%亚组,各74例)和长事件组(长TAD亚组、长AHT%亚组,各222例),并进一步分析各组TAD、AHT%和AHI与血氧指标的相关性。结果轻、中、重度OSA组患者性别、年龄、BMI、颈围、日间嗜睡、高血压史、糖尿病史比较Background The prevalence of obstructive sleep apnea(OSA)has been increasing year by year,but the current diagnostic criteria of apnea-hypopnea index(AHI)>5 times/h commonly used for OSA has gradually revealed drawbacks in the diagnosis,severity evaluation,treatment effect and long-term complications prediction of the disease.This study proposed that there is a need for more information about the duration of apnea-hypopnea for assessing OSA in addition to AHI.Objective To investigate the significance of duration of respiratory events in nocturnal hypoxemia in adults with OSA.Methods A total of 296 patients with suspected OSA who were admitted to the sleep monitoring room of the First Hospital of Shanxi Medical University from October 2021 to March 2022 were selected as the study subjects.Before PSG,the subjects underwent a physical examination in terms of height,body mass,neck circumference,and were asked about their sleep history,as well as history of hypertension and diabetes.The subjects were divided into three groups according to AHI of 5 times/h≤AHI<15 times/h as the mild OSA group(n=56),15 times/h≤AHI<30 times/h as the moderate OSA group(n=62),AHI≥30 times/h as the severe OSA group(n=178).The three groups were compared for blood oxygen indexes[lowest oxygen saturation(LSpO_(2)),mean oxygen saturation(MSpO_(2)),baseline oxygen saturation(BSpO_(2)),oxygen desaturation index(ODI),oxygen saturation(SpO_(2))below 90%in total sleep time(T90)]and duration parameters of respiratory events[mean total apnea duration(MTAD),mean hypopnea duration(MHD),mean apnea-hypopnea duration(MAD),the longest apnea duration(LTAD),the longest hypopnea duration(LHD),the longest apnea-hypopnea duration(LAD),total apnea-hypopnea duration(TAD),AHI,percentage of apnea/hypopnea time from total sleep time(AHT%)].Spearman rank correlation analysis was used to investigate the correlation between respiratory event duration parameters and blood oxygen indexes.The OSA patients were divided into the short event group(short TAD subgroup,sho

关 键 词：睡眠呼吸暂停 阻塞性 低氧血症 呼吸事件持续时间 呼吸暂停低通气指数 多导睡眠监测 

分 类 号：R563.8[医药卫生—呼吸系统]