不同年龄阻塞性睡眠呼吸暂停患者睡眠结构参数差异及其与日间脑功能状态的关系  

Differences of sleep structure parameters in patients with obstructive sleep apnea at different ages and the relationship with daytime brain functional status

作　　者：张硕楠 王爽 张思宇 ZHANG Shuonan;WANG Shuang;ZHANG Siyu(Department of Otolaryngology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100096,China)

机构地区：[1]首都医科大学附属北京积水潭医院耳鼻咽喉科,北京100096

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第5期55-62,69,共9页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨不同年龄阻塞性睡眠呼吸暂停(OSA)患者睡眠结构参数差异及其与日间脑功能状态的关系。方法选择2019年4月-2022年5月收治的200例OSA患者为研究对象,根据年龄将患者分为青年组(<40岁),中年组(41~65岁),老年组(>65岁),按1∶1∶1匹配后,3组患者均纳入48例并比较临床资料,包括多导睡眠监测(PSG)睡眠结构参数、静息态脑电波(rs-EEG)测量日间脑功能状态定量;采用Logistic回归分析睡眠结构参数与日间脑功能状态之间的关系;采用受试者工作特征曲线(ROC)分析各指标在不同年龄层对PSG结果及脑功能状态的诊断价值。结果中年组患者快波睡眠次数、N2期睡眠比率、快速眼动睡眠(REM)期比率、脑混沌指数、外专注指数、内专注指数均高于青年组和老年组;中年组慢波睡眠次数、内源性焦虑指数、反应速度指数较青年组低,差异均具有统计学意义(P<0.05)。多因素结果显示慢波睡眠次数、快波睡眠次数、N2期睡眠比率及REM期比率是不同年龄OSA患者日间脑功能状态改变的独立危险因素。慢波睡眠次数与脑混沌指数、反应速度指数、内专注指数呈负相关;快波睡眠次数和N2期睡眠比率与脑混沌指数、外专注指数呈正相关;REM期比率与脑混沌指数、内源性焦虑指数、内专注指数呈正比。在中年组中,当睡眠呼吸暂停低通气指数(AHI)≥5、≥15、≥30次/h时,快波睡眠次数、N2期睡眠比率及REM期比率对其诊断OSA及严重程度有高度预测价值;在青年组和老年组中,AHI≥30次/h时快波睡眠次数可高度预测青年组患者诊断中度、重度OSA价值,N2期睡眠比率和REM期比率可高度预测老年组患者诊断中度OSA价值。结论OSA患者睡眠及脑状态在不同年龄分层中有显著差异性,41~65岁OSA患者睡眠质量最差且日间脑功能状态改变明显,41~65岁患者睡眠结构慢波睡眠次数、快波睡眠次数、N2期睡眠比率、REM期�Objective To explore the differences of sleep structure parameters in patients with obstructive sleep apnea(OSA)at different ages and the relationship with brain functional status.Methods A total of 200 OSA patients admitted to our hospital from April 2019 to May 2022 were selected as the study subjects,and the patients were divided into the young group(<40 years old),the middle-aged group(41-65 years old),and the elderly group(>65 years old)according to age.After 1∶1∶1 matching,48 patients were in each of the three groups,and their clinical data were compared.Polysomnography(PSG)was used to measure sleep structure parameters and resting state electroencephalography(rs-EEG)to measure daytime brain function.Logistic regression was adopted to analyze the relationship between sleep structure parameters and daytime brain function status.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of PSG results and brain function status in different age groups.Results The number of fast wave sleep,N2 sleep ratio,rapid eye movement(REM)sleep ratio,brain chaos index,external concentration index and internal concentration index in the middle-aged group were higher than those in the young and elderly groups.The number of slow wave sleep,endogenous anxiety index and reaction speed index in the middle-aged group were lower than those in the young group,and the differences were statistically significant(P<0.05).The multivariate analysis results showed that the number of slow wave sleep,the number of fast wave sleep,N2 sleep ratio and REM sleep ratio were independent risk factors for changing daily brain function status in OSA patients of different ages.The number of slow wave sleep was negatively correlated with brain chaos index,response speed index and internal concentration index.The number of fast wave sleep and N2 sleep ratio were positively correlated with brain chaos index and external concentration index.The REM sleep ratio was positively proportional to brain chaos index,endogenous anxie

关 键 词：阻塞性睡眠呼吸暂停 睡眠结构参数 日间脑功能状态 年龄 

分 类 号：R766.4[医药卫生—耳鼻咽喉科]