广州市区阻塞性睡眠呼吸暂停低通气综合征流行病学调查
发布时间：2018-07-17 03:24
【摘要】：阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)是成人睡眠呼吸障碍(sleep-disordered breathing,SDB)中最常见的一种,可导致患者白天嗜睡,心脑肺血管并发症乃至多脏器损害。目前,我国大陆地区OSAHS的流行病学资料较为有限,仅上海、承德、太原、福州有相关大样本报道。如果采用诊断OSAHS的“金标准”对所有被调查者进行全夜多导睡眠图(polysomnography,PSG)监测,费时且成本极大。故本研究首先对便携式睡眠监测(portable monitor,PM)和PSG监测的差异性做出评估,在确定其准确度的基础上对筛查出的OSAHS可疑人群行PM,以此得出广州市区OSAHS的患病率,为制定相关防治策略提供依据。 第一部分便携式睡眠监测和多导睡眠监测的差异性研究 目的 比较PM与PSG两种监测方法在临床上诊断OSAHS的差异性,为评估PM筛查OSAHS的诊断价值提供依据。 方法 纳入有夜间打鼾,伴或不伴呼吸暂停的患者,仔细询问病史(白天的精神状况,有无其他睡眠疾病或慢性疾病史)。患者先于我院睡眠中心行PSG监测,后由专业的睡眠技术人员对其指导PM的使用方法及注意事项,于家中自行监测睡眠状况。将两组监测结果进行统计分析,比较其各主要参数的差异性,并分析PM的诊断OSAHS的准确度。 结果 1.入选50例疑似OSAHS的患者,其中男性46例,女性4例,平均年龄44.86±11.22岁,35-60岁的有30例,患者平均体重指数(body mass index,BMI)为26.64±3.17。 2. PM与PSG在监测睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)、氧减指数、夜间最低血氧饱和度、平均血氧饱和度等参数上无明显差异(P0.05),PM的灵敏度为97.62%,特异度为75%,阳性似然比为3.9048,阴性似然比为0.0317,阳性预测价值为0.1078,阴性预测价值为0.9990。 3. PM与PSG测得AHI的一致性由Bland-Altman plot得出。 结论 PM与PSG两种方法监测的主要参数的差异性无统计学意义,PM灵敏度较高但特异度较低,故针对一些有明显OSAHS症状的疑似患者可进行筛查,有一定诊断意义。 第二部分广州市区阻塞性睡眠呼吸暂停低通气综合征流行病学调查 目的 了解广州市区OSAHS的患病率,为宣传及防治该疾病的危害性提供参考数据。 方法 采用整群抽样的方法对广州市的越秀区、天河区、荔湾区、海珠区、白云区、罗岗区、番禺区、黄埔区8个区的常住居民共7684人,进行入户问卷调查,筛选出Epworth嗜睡量表(epworth sleepiness scale,ESS)总分≥9分的人群,对其中中重度打鼾人群行PM,估算出人群OSAHS的患病率。 结果 实际完成调查问卷6712份,应答率87.35%,有效问卷5620份,有效率为83.73%,ESS总分≥9分的共363例(6.46%),其中90例伴中重度打鼾,73例同意行PM。ESS总分≥9分在≤30岁和40-49岁两个年龄组人数最多,女性人数多于男性,但男性普遍总分较高。吸烟、饮酒与ESS评分相关。公众对OSAHS的认知程度偏低。按AHI≥5次/h且ESS总分≥9分为诊断标准,估算出人群OSAHS患病率为1.45%。 结论 广州市OSAHS的患病率为1.45%。公众对OSAHS的认知程度偏低,应积极宣传其危害性,引起医务工作者和大众的足够重视。
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) is the most common type of adult sleep and respiratory disorder (sleep-disordered breathing, SDB), which can lead to daytime sleepiness, cardiovascular and pulmonary vascular complications and even multiple organs damage. Currently, the epidemiology of OSAHS in the mainland of China Shanghai, Chengde, Taiyuan, and Fuzhou have relatively large sample reports. If the "gold standard" for diagnostic OSAHS is used to monitor all night polysomnography (polysomnography, PSG) for all the respondents, it is time-consuming and costly. This study first made the difference between portable monitor (PM) and PSG monitoring. On the basis of the assessment, PM was performed on the screened OSAHS suspected population on the basis of its accuracy, so as to obtain the prevalence of OSAHS in Guangzhou City, and to provide the basis for the formulation of relevant prevention and control strategies.
The first part is the difference between portable sleep monitoring and polysomnography.
objective
To compare the difference between the two monitoring methods of PM and PSG in clinical diagnosis of OSAHS, so as to provide basis for evaluating the diagnostic value of PM screening for OSAHS.
Method
The patients who had nocturnal snoring, accompanied by or without apnea, were carefully inquiring about the history of the disease (the mental state of the day, with or without other sleep or chronic disease history). The patients were monitored by PSG in the sleep center of our hospital, and then the professional sleep technicians monitored the use of PM and the precautions of their use and monitored their sleep conditions at home. Two groups of monitoring results were statistically analyzed, compared the difference of their main parameters, and analyzed the accuracy of PM diagnosis OSAHS.
Result
1. patients were enrolled in 50 cases of suspected OSAHS, of which 46 were male, 4 were female, the average age was 44.86 + 11.22 years, and 35-60 years old, and the average body mass index (body mass index, BMI) was 26.64 + 3.17..
There was no significant difference between 2. PM and PSG in monitoring sleep apnea hypopnea index (apnea-hypopnea index, AHI), oxygen subtraction index, minimum oxygen saturation at night and average oxygen saturation (P0.05). The sensitivity of PM was 97.62%, the specificity was 75%, the positive likelihood ratio was 3.9048, the negative likelihood ratio was 0.0317, the positive predictive value was 0.1078, Yin was negative. The predictive value of sex is 0.9990.
3. the consistency of AHI measured by PM and PSG is derived from Bland-Altman plot.
conclusion
The difference between the main parameters of the two methods of PM and PSG is not statistically significant, the sensitivity of PM is high, but the specificity is low, so it can be screened for some suspected patients with obvious OSAHS symptoms and has certain diagnostic significance.
The second part is the epidemiological survey of obstructive sleep apnea hypopnea syndrome in Guangzhou.
objective
Objective to understand the prevalence of OSAHS in urban areas of Guangzhou, and to provide reference data for publicizing and preventing the disease.
Method
By cluster sampling, 7684 people living in 8 districts of Yuexiu District, Tianhe District, Liwan District, Haizhuqu District, Baiyun District, Luo Gang District, Panyu District and Whampoa district were surveyed by questionnaire, and the total score of Epworth Sleepiness Scale (ESS) (Epworth scale, ESS) was more than 9, and PM was used to estimate the moderate and severe snoring population. Calculate the prevalence of OSAHS in the crowd.
Result
6712 questionnaires were completed, the response rate was 87.35%, the effective questionnaire was 5620, the effective rate was 83.73%, and the total score of ESS was more than 9 (6.46%). Among them, 90 cases were snoring with moderate to severe snoring and 73 agreed that the total score of the PM.ESS total score was more than 9 in the two age groups of less than 30 years and 40-49 years, and the number of women was more than that of men, but the general total score of male was higher. Smoking and drinking were higher. Alcohol is associated with ESS score. The public is less aware of OSAHS. According to AHI > 5 /h and ESS total score of 9 or more as diagnostic criteria, the OSAHS prevalence rate is estimated to be 1.45%..
conclusion
The prevalence rate of OSAHS in Guangzhou is 1.45%.. The public is less aware of OSAHS. We should actively publicize its harmfulness and attract enough attention from medical workers and the public.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) is the most common type of adult sleep and respiratory disorder (sleep-disordered breathing, SDB), which can lead to daytime sleepiness, cardiovascular and pulmonary vascular complications and even multiple organs damage. Currently, the epidemiology of OSAHS in the mainland of China Shanghai, Chengde, Taiyuan, and Fuzhou have relatively large sample reports. If the "gold standard" for diagnostic OSAHS is used to monitor all night polysomnography (polysomnography, PSG) for all the respondents, it is time-consuming and costly. This study first made the difference between portable monitor (PM) and PSG monitoring. On the basis of the assessment, PM was performed on the screened OSAHS suspected population on the basis of its accuracy, so as to obtain the prevalence of OSAHS in Guangzhou City, and to provide the basis for the formulation of relevant prevention and control strategies.
The first part is the difference between portable sleep monitoring and polysomnography.
objective
To compare the difference between the two monitoring methods of PM and PSG in clinical diagnosis of OSAHS, so as to provide basis for evaluating the diagnostic value of PM screening for OSAHS.
Method
The patients who had nocturnal snoring, accompanied by or without apnea, were carefully inquiring about the history of the disease (the mental state of the day, with or without other sleep or chronic disease history). The patients were monitored by PSG in the sleep center of our hospital, and then the professional sleep technicians monitored the use of PM and the precautions of their use and monitored their sleep conditions at home. Two groups of monitoring results were statistically analyzed, compared the difference of their main parameters, and analyzed the accuracy of PM diagnosis OSAHS.
Result
1. patients were enrolled in 50 cases of suspected OSAHS, of which 46 were male, 4 were female, the average age was 44.86 + 11.22 years, and 35-60 years old, and the average body mass index (body mass index, BMI) was 26.64 + 3.17..
There was no significant difference between 2. PM and PSG in monitoring sleep apnea hypopnea index (apnea-hypopnea index, AHI), oxygen subtraction index, minimum oxygen saturation at night and average oxygen saturation (P0.05). The sensitivity of PM was 97.62%, the specificity was 75%, the positive likelihood ratio was 3.9048, the negative likelihood ratio was 0.0317, the positive predictive value was 0.1078, Yin was negative. The predictive value of sex is 0.9990.
3. the consistency of AHI measured by PM and PSG is derived from Bland-Altman plot.
conclusion
The difference between the main parameters of the two methods of PM and PSG is not statistically significant, the sensitivity of PM is high, but the specificity is low, so it can be screened for some suspected patients with obvious OSAHS symptoms and has certain diagnostic significance.
The second part is the epidemiological survey of obstructive sleep apnea hypopnea syndrome in Guangzhou.
objective
Objective to understand the prevalence of OSAHS in urban areas of Guangzhou, and to provide reference data for publicizing and preventing the disease.
Method
By cluster sampling, 7684 people living in 8 districts of Yuexiu District, Tianhe District, Liwan District, Haizhuqu District, Baiyun District, Luo Gang District, Panyu District and Whampoa district were surveyed by questionnaire, and the total score of Epworth Sleepiness Scale (ESS) (Epworth scale, ESS) was more than 9, and PM was used to estimate the moderate and severe snoring population. Calculate the prevalence of OSAHS in the crowd.
Result
6712 questionnaires were completed, the response rate was 87.35%, the effective questionnaire was 5620, the effective rate was 83.73%, and the total score of ESS was more than 9 (6.46%). Among them, 90 cases were snoring with moderate to severe snoring and 73 agreed that the total score of the PM.ESS total score was more than 9 in the two age groups of less than 30 years and 40-49 years, and the number of women was more than that of men, but the general total score of male was higher. Smoking and drinking were higher. Alcohol is associated with ESS score. The public is less aware of OSAHS. According to AHI > 5 /h and ESS total score of 9 or more as diagnostic criteria, the OSAHS prevalence rate is estimated to be 1.45%..
conclusion
The prevalence rate of OSAHS in Guangzhou is 1.45%.. The public is less aware of OSAHS. We should actively publicize its harmfulness and attract enough attention from medical workers and the public.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766
【参考文献】
相关期刊论文 前8条
1 时延伟;王广发;张成;马靖;宿利;贾鹏;罗义萍;魏淑敏;;Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用价值[J];中国呼吸与危重监护杂志;2009年05期
2 李进让;陈曦;孙建军;孙玉梅;章榕;李春风;胡q，
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