阻塞性睡眠呼吸暂停综合征患者多导睡眠监测性别差异的研究  

Gender differences in the polysomnographic characteristics in patients with obstructive sleep apnea syndrome

作　　者：丁秀[1] 袁世针 王小轶[1] DING Xiu;YUAN Shizhen;WANG Xiaoyi(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)

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

出　　处：《中国耳鼻咽喉头颈外科》2024年第7期456-460,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金面上项目(81773505)。

摘　　要：目的评估阻塞性睡眠呼吸暂停综合征(OSAS)患者多导睡眠监测(PSG)结果中呼吸事件和睡眠结构的性别差异。方法回顾性分析2023年1~8月因睡眠打鼾就诊于北京同仁医院,完成整夜PSG,呼吸暂停低通气指数(AHI)≥5次/h均诊断为OSAS的成年人患者。比较男性和女性OSAS患者的基本特征、呼吸事件和睡眠结构。结果共纳入380例OSAS患者,其中男293例(77.1%),女87例(22.9%)。年龄22~78(44.4±11.5)岁,体重指数(BMI)为15.8~39.9(26.5±3.9)kg/m^(2),AHI为5.0~115.8(34.9±24.8)次/h,最低血氧饱和度(lowest oxygen saturation,LSpO_(2))为43%~97%(80.7±11.6)%。男性和女性OSAS患者比较,AHI值男性高于女性[(37.9±24.8)次/h vs.(24.5±21.7)次/h,P=0.000],REM期AHI值男性高于女性[(36.7±23.2)次/h vs.(30.9±22.8)次/h,P=0.040],LSpO_(2)男性低于女性[(79.2±12.0)%vs.(85.7±8.3)%,P=0.000];觉醒指数、睡眠有效率、一期睡眠占总睡眠时间百分比和三期睡眠占总睡眠时间百分比,差异比较均有统计学意义。50岁以上男性和女性OSAS患者,AHI值男性高于女性[(39.3±21.4)次/h vs.(30.5±23.0)次/h,P=0.029],LSpO_(2)、REM期AHI值差异无显著性。睡眠结构性别间的差异与研究对象总体一致。结论男性OSAS患者AHI值、LSpO_(2)较女性患者严重,慢波睡眠减少更为明显;女性更年期后病情加重,突出表现为REM期呼吸事件增多、LSpO_(2)下降更严重。女性激素对OSAS的保护作用主要是减轻REM期呼吸事件和低氧损伤,而不是通过改善睡眠结构。OBJECTIVE To investigate the polysomnographic differences between males and females with obstructive sleep apnea syndrome(OSAS).METHODS Adults visited to Beijing Tongren Hospital for sleep snoring from January 2023 to August 2023 who completed overnight polysomnography(PSG)and whose apnea hypopnea index(AHI)≥5 times/h were diagnosed as OSAS patients in this study.The general information,respiratory events and sleep structure were compared between male and female OSAS patients.RESULTS A total of 380 patients were included in this study with 293 males(77.1%)and 87 females(22.9%).Mean age was(44.4±11.5)years,and the mean body mass index was(26.5±3.9)kg/m^(2);AHI ranged between 5.0 and 115.8 times/h with a mean of(34.9±24.8)times/h;lowest oxygen saturation(LSpO_(2))ranged between 43%-97%with a mean of(80.7±11.6)%.Between male and female OSAS patients,the AHI in males was higher than females[(37.9±24.8)times/h vs.(24.5±21.7)times/h,P=0.000],and the AHI in REM was higher in males than females[(36.7±23.2)times/h vs.(30.9±22.8)times/h,P=0.040].LSpO_(2)was lower in males than females[(79.2±12.0)%vs.(85.7±8.3)%,P=0.000].There were significant differences for arousal index,sleep efficiency,N1 sleep percent and N3 sleep percent between two groups.Between male and female OSAS patients over 50 years old,AHI was still higher in males than in females[(39.3±21.4)times/h vs.(30.5±23.0)times/h,P=0.029],and there was no significant difference in AHIREM and LSpO_(2).The difference in sleep structure between male and female OSAS patients over 50 years old was consistent with that of participants.CONCLUSION The AHI and LSpO_(2)of male OSAS patients were more serious than those of female OSAS patients,and the reduction of slow wave sleep was more obvious.OSAS became worse after menopause,which was highlighted by the increase of respiratory events in REM and the more serious decline of LSpO_(2).The protective effect of female hormones on OSAS is mainly to alleviate REM respiratory events and hypoxia damage,rather than impro

关 键 词：睡眠呼吸暂停 阻塞性 性别 多导睡眠监测 睡眠结构 慢性间断性缺氧 

分 类 号：R766[医药卫生—耳鼻咽喉科]