阻塞性睡眠呼吸暂停低通气综合征患者夜间持续气道正压通气治疗压力及其影响因素  

Continuous positive airway pressure non-invasive ventilation during nighttime in patients with obstructive sleep apnea hypopnea syndrome and influencing factors

作　　者：蒋雪龙 韩美荣 杨行妹 吴帅 石娟 吾云 张庆龙 马士林 孙勇[4] 何忠明 韩芳[5] Jiang Xuelong;Han Meirong;Yang Hangmei;Wu Shuai;Shi Juan;Wu Yun;Zhang Qinglong;Ma Shilin;Sun Yong;He Zhongming;Han Fang(Department of Pulmonary and Critical Care Medicine,Karamay Hospital,People's Hospital of Xinjiang Uygur Autonomous Region,Karamay 834000,China;The Third Clinical Medical College,Xinjiang Medical University,Urumqi 830067,China;School of Public Health,Xinjiang Medical University,Urumqi 830017,China;Health Management Center,the First Affiliated Hospital of Xinjiang Medical Universitty,Urumqi 830054,China;Department of Sleep Medicine,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]新疆维吾尔自治区人民医院克拉玛依医院(克拉玛依市中心医院)呼吸与危重症医学科,克拉玛依834000 [2]新疆医科大学第三临床医学院,乌鲁木齐830067 [3]新疆医科大学公共卫生学院,乌鲁木齐830017 [4]新疆医科大学第一附属医院健康管理中心,乌鲁木齐830054 [5]北京大学人民医院睡眠医学科,北京100044

出　　处：《国际呼吸杂志》2024年第9期1005-1011,共7页International Journal of Respiration

基　　金：国家自然科学基金(82160023);新疆自然科学基金(2022D01A21);新疆维吾尔自治区“天山英才”医药卫生高层次人才培养计划领军人才(TSYC202301A045);克拉玛依市首届科技创新人才。

摘　　要：目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间持续气道正压通气(CPAP)治疗压力及其影响因素。方法本研究为横断面研究。采用目的抽样的方法纳入2021年4月至2023年12月在克拉玛依市中心医院行夜间呼吸监测和CPAP治疗的164例OSAHS患者。根据民族不同分为汉族组(132例)和维吾尔族组(32例)。所有患者行睡眠监测和血氧监测记录呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSaO_(2))、夜间平均氧饱和度(MSaO_(2))、氧减指数(ODI)、血氧饱和度低于90%的时间占总记录时间百分比(SIT90)。所有患者行夜间CPAP压力滴定,记录CPAP治疗压力数据,包括最大压力、中位压力、CPAP治疗90%时间内的平均压力滴定值(P90)、CPAP治疗95%时间内的平均压力滴定值(P95)。比较2组患者一般资料、睡眠呼吸监测和夜间CPAP治疗压力数据。比较不同性别OSAHS患者一般资料、睡眠呼吸监测和夜间CPAP治疗压力数据。采用多元线性回归分析OSAHS患者CPAP治疗最大压力、P90的相关影响因素。结果汉族组中男91例,女41例,年龄(58.90±9.01)岁;维吾尔族组中男10例,女22例,年龄(56.38±8.57)岁。汉族组与维吾尔族组患者年龄、身体质量指数、颈围、AHI、ODI、LSaO_(2)和MSaO_(2)比较差异均无统计学意义(均P>0.05);性别、腹围和SIT90比较差异均有统计学意义(均P<0.05)。2组患者夜间CAPA治疗中最大压力、P95和P90比较差异均无统计学意义(均P>0.05),汉族组中位压力较维吾尔族组高[9.90(7.13,11.28)cmH 2O(1 cmH 2O=0.098 kPa)比8.90(7.30,11.10)cmH 2O],差异有统计学意义(Z=2.21,P=0.027)。男性和女性OSAHS患者年龄、颈围、腹围、AHI、ODI、LSaO_(2)、MSaO_(2)、SIT90比较差异均无统计学意义(均P>0.05),仅身体质量指数比较差异有统计学意义[(28.30±3.44)kg/m^(2)比(30.46±6.57)kg/m^(2),t=2.41,P=0.018]。男性和女性OSAHS患者夜间CPAP治疗P95、P90和中位压力比较差异均Objective To analyze the status of continuous positive airway pressure(CPAP)non-invasive ventilation during nighttime in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)and influencing factors.Methods This was a cross-sectional study.Totally 164 OSAHS patients treated with nighttime respiratory monitoring by polysomnography(PSG)and CPAP in Karamay Central Hospital from April 2021 to December 2023 were enrolled using purposive sampling.Among them,there were 132 cases of the Han nationality and 32 cases of the Uygurs.All patients were monitored for sleeping and oxygen saturation,including the parameters of apnea hypopnea index(AHI),minimum oxygen saturation during nighttime(LSaO_(2)),mean oxygen saturation during nighttime(MSaO_(2)),oxygen desaturation index(ODI),and the percentage of time when blood oxygen saturation was below 90%in the total recorded time(SIT90%).CPAP pressure was recorded during nighttime,and parameters of the maximum pressure,median pressure,average pressure value(P90)during 90%of CPAP treatment,and average pressure value(P95)during 95%of CPAP treatment were recorded and compared between groups.The general data,sleep apnea monitoring,and nocturnal CPAP therapy pressure data during nighttime of OSAHS patients in the two groups and different genders were compared.Multiple linear regression was used to analyze influencing factors for the maximum pressure and P90 during CPAP treatment in OSAHS patients.Results There were 91 males and 41 females in the Han group,with a mean age of 58.90±9.01 years.There were 10 males and 22 females in the Uyghur group,with a mean age of 56.38±8.57 years.There were no significant differences in age,body mass index(BMI),neck circumference,AHI,ODI,LSaO_(2),MSaO_(2),and maximum pressure,P95,and P90 between the Han and Uyghur groups(all P>0.05),and there were statistically significant differences in gender,abdominal circumference and SIT90(all P<0.05).The median pressure in the Han group was significantly higher than that in the Uyghur groups(9.90[7.13,11

关 键 词：睡眠呼吸暂停 阻塞性 无创通气 多导睡眠监测 压力滴定 

分 类 号：R766[医药卫生—耳鼻咽喉科]