肥胖程度及睡眠体位对阻塞性睡眠呼吸暂停低通气综合征患者的影响研究

发布时间：2018-04-05 11:32

本文选题：睡眠呼吸暂停　切入点：阻塞性　出处：《中国全科医学》2017年11期

【摘要】：背景肥胖是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发病公认的危险因素之一,改变睡眠体位作为OSAHS的一种治疗手段已被广泛推荐,不同肥胖程度患者改变睡眠体位是否均能影响OSAHS严重程度,国内尚未见相关研究报道。目的探讨肥胖程度及睡眠体位对OSAHS的影响,以及体位性OSAHS与肥胖相关指标的相关性。方法回顾性分析2015年1月—2016年6月四川大学华西医院睡眠呼吸监测室行多导睡眠图(PSG)监测并诊断为OSAHS的患者678例。收集患者一般资料及PSG监测指标,根据体质指数(BMI)将患者分为体质量正常组(n=139)、超重组(n=315)、肥胖组(n=224),分析其PSG监测指标及体位依赖性指数;根据体位依赖性指数将患者分为体位性OSAHS组(n=288)及非体位性OSAHS组(n=390),分析其肥胖相关人体测量指标和PSG监测指标,以及体位性OSAHS的影响因素。结果体质量正常组、超重组、肥胖组患者Epworth嗜睡量表(ESS)评分、微觉醒指数、呼吸努力相关微觉醒(RERA)指数、呼吸暂停低通气指数(AHI)、血氧饱和度(SaO_2)90%时间占总睡眠时间(TST)比例、平均血氧饱和度(MSaO_2)、最低血氧饱和度(LSaO_2)、非仰卧位AHI、仰卧位AHI、体位依赖性指数比较,差异均有统计学意义(P0.05)。体位性OSAHS组患者男性比例、BMI、腰围、臀围、腰臀比、ESS评分、微觉醒指数、RERA指数、AHI、SaO_290%时间占TST比例低于非体位性OSAHS组,MSaO_2、LSaO_2高于非体位性OSAHS组(P0.05)。Spearman相关分析结果显示,体位依赖性指数与BMI、腰围、臀围、腰臀比均呈负相关(r_s=-0.295、-0.289、-0.219、-0.236,P0.001)。多因素Logistic回归分析结果显示,性别[OR=0.620,95%CI(0.392,0.979),P=0.040]和BMI[OR=0.879,95%CI(0.802,0.943),P=0.001]与体位性OSAHS有回归关系。结论 OSAHS的病情严重程度与肥胖程度呈正相关,而BMI与体位依赖性指数呈负相关,性别和BMI是体位性OSAHS的独立影响因素,BMI越高,患者改变睡眠体位对呼吸事件的影响越小,单纯改变睡眠体位可能无法改善该类患者的病情,应尽早考虑联合更为积极的治疗。
[Abstract]:Background Obesity is one of the recognized risk factors for the development of obstructive sleep apnea hypopnea syndrome (OSAHS). Changing sleep posture as a treatment for OSAHS has been widely recommended.Whether the change of sleep posture can affect the severity of OSAHS in patients with different obesity degree has not been reported in China.Objective to investigate the effects of obesity and sleep posture on OSAHS and the correlation between postural OSAHS and obesity.Methods from January 2015 to June 2016, 678 patients with OSAHS were examined by polysomnography and polysomnography (PSG) in sleep monitoring room of West China Hospital of Sichuan University.The patients were divided into three groups according to body mass index (BMI), including normal body mass group (139g), superrecombination group (315g) and obese group (224g). The PSG monitoring index and postural dependence index were analyzed.Patients were divided into postural OSAHS group (n = 288) and non-postural OSAHS group (n = 390) according to postural dependency index. The obesity related anthropometric indexes, PSG monitoring indexes and the influencing factors of postural OSAHS were analyzed.Results the scores of Epworth sleepiness scale, microarousal index, respiratory effort related arousal index, apnea hypopnea index (AHI) and oxygen saturation (Sao) were 90% of total sleep time (TST) in normal body mass group, hyperrecombination group and obesity group.The mean blood oxygen saturation was MSaO _ 2, the lowest blood oxygen saturation was LSaO _ 2, the non-supine AHIs, the supine AHIs, the postural dependence indexes were significantly different (P 0.05).There was a negative correlation between body position dependence index and BMI, waist circumference, hip circumference and waist-to-hip ratio.Conclusion the severity of OSAHS is positively correlated with the degree of obesity, while BMI is negatively correlated with postural index. Gender and BMI are independent influencing factors of postural OSAHS.Changes in sleep posture alone may not improve the condition of this type of patients, should be considered as early as possible in combination with more active treatment.
【作者单位】：四川大学华西医院呼吸与危重症医学科;成都上锦南府医院呼吸与危重症医学科;四川大学华西医院睡眠医学中心;
【分类号】：R766;R589.2

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