成年男性OSAHS患者日间嗜睡相关因素分析

发布时间：2018-11-23 09:37

【摘要】：目的:分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者日间嗜睡(EDS)相关因素。探讨OSAHS患者EDS与年龄、体块指数(BMI)、呼吸暂停低通气指数(AHI)、呼吸暂停指数(AI)、低通气指数(HI)、夜间最低血氧饱和度(最低Sp02)、夜间平均血氧饱和度(平均Sp0_2)、血氧饱和度低于90%的时间占总睡眠时间的百分比(TS90)、微觉醒、非快动眼睡眠1期占总睡眠时间的比值(S1%),非快动眼睡眠2期占总睡眠时间的比值(S2%),非快动眼睡眠1和2期占总睡眠时间的比值(S1+2%),非快动眼睡眠3和4期占总睡眠时间的比值(S3+4%),快动眼睡眠时间占总睡眠时间的比值(REM%)、睡眠效率相关性。方法:通过多导睡眠监测诊断OSAHS,行Epworth嗜睡评分量表问卷调查,并测量身高、体重,计算体块指数(BMI)。依据Epworth嗜睡量表得分,将64例成年男性OSAHS患者划分为无嗜睡组、轻度嗜睡组、中度嗜睡组及重度嗜睡组。血氧饱和度和呼吸暂停低通气指数按照国内2002年制定的《阻塞性睡眠呼吸暂停低通气综合征诊治指南》分组,分为正常血氧组,轻度低血氧组,中度低血氧组及重度低血氧组;AHI轻度,中度及重度。分析影响OSAHS患者日间嗜睡因素。结果:入选OSAHS患者中,轻、中度嗜睡例数占较大比例。四组不同嗜睡程度的OSAHS患者AHI、AI、TS90随嗜睡程度的加重而增高。重度嗜睡组的AHI、TS90与无嗜睡组比较,差别有统计学意义(P0.05),而轻、中度嗜睡组与无嗜睡组比较无统计学差异。中、重度嗜睡组和无嗜睡组的AI比较,有统计学意义,而轻度嗜睡组与无嗜睡组比较无统计学意义。重度嗜睡组和无嗜睡组的平均Sp02比较有显著差异(P0.05),而轻、中度嗜睡组与无嗜睡组比较无统计学差异。重度嗜睡组和无嗜睡组S1+2%比较,有统计学意义(t=-2.402, P0.05),而轻、中度嗜睡组与无嗜睡组比较无统计学差异。中、重度嗜睡组S3+4%、睡眠效率分别与无嗜睡组比较,有统计学差异(P0.05),轻度嗜睡组与无嗜睡组比较无统计学差异。不同程度的平均血氧饱和度的OSAHS患者ESS评分随着平均血氧饱和度的下降ESS评分增高,中、重度低血氧组分别与正常血氧组比较,有统计学差异,P0.05。而不同程度最低血氧饱和度的OSAHS患者组间ESS评分无统计学差异。S1+2期睡眠所占睡眠时间百分比随嗜睡程度加重而增高,睡眠效率、S3+4期睡眠所占睡眠时间百分比随嗜睡程度加重而降低。ESS评分与AHI、AI、HI、TS90呈正相关。ESS评分与平均Sp0_2、睡眠效率呈负相关。排除混杂因素后,嗜睡程度和AHI、TS90呈正相关,和睡眠效率呈负相关。与睡眠微觉醒关性较差。结论: OSAHS患者EDS与AHI、AI、夜间最低Sp02、夜间平均Sp0_2、TS90、S1+2%、S3+4%、睡眠效率关系密切。以上因素影响OSAHS患者的EDS的严重程度。AHI越高,低氧血症越重且持续的时间越长,浅睡眠所占比例越大,深睡眠所占比例越小,睡眠效率越差,OSAHS患者EDS越重。
[Abstract]:Objective: to analyze the related factors of daytime sleepiness (EDS) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). To investigate the relationship between EDS and age, body mass index (BMI), apnea hypopnea index (AHI), apnea index (AI), hypopnea index (HI), nocturnal minimum oxygen saturation (minimum Sp02) in patients with OSAHS. The mean nocturnal oxygen saturation (Sp0_2), the percentage of time below 90% of total sleep time (TS90), the ratio of microarousal, non-rapid eye movement sleep stage 1 to total sleep time (S1%), The ratio of non-REM sleep stage 2 to total sleep time (S2%), non-REM sleep stage 1 and stage 2 to total sleep time (S 1 2%), non-rapid eye sleep stage 3 and 4 to total sleep time (S 3 4%), The ratio of REM sleep time to total sleep time (REM%) was correlated with sleep efficiency. Methods: polysomnography diagnosis OSAHS, was investigated with Epworth somnolence scale, height, weight and mass index (BMI). Were calculated. According to the scores of Epworth somnolence scale, 64 adult male patients with OSAHS were divided into three groups: no sleepiness group, mild somnolence group, moderate somnolence group and severe sleepiness group. According to the guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (OSAS), the patients were divided into normal oxygen group, mild hypoxic group, moderate hypoxic group and severe hypoxic group according to the guidelines for diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (OSAS). AHI is mild, moderate and severe. The factors affecting daytime sleepiness in OSAHS patients were analyzed. Results: mild and moderate somnolence was more common in patients with OSAHS. AHI,AI,TS90 increased with the aggravation of somnolence in four groups of OSAHS patients with different degrees of somnolence. The AHI,TS90 of severe somnolence group was significantly higher than that of non-somnolence group (P0.05), but there was no significant difference between mild and moderate somnolence group and non-somnolence group. There was significant difference in AI between moderate and severe sleepiness group and no somnolence group, but there was no significant difference between mild somnolence group and non-somnolence group. There was significant difference in average Sp02 between severe sleepiness group and non somnolence group (P0.05), but there was no significant difference between mild and moderate somnolence group and no somnolence group. There was significant difference between severe sleepiness group and non-somnolence group in S _ 1 _ 2% (tng-2.402, P0.05), but there was no statistical difference between mild and moderate sleepiness group and non-somnolence group. There were significant differences in sleep efficiency between moderate and severe narcolepsy group compared with non-sleepiness group (P0.05), while there was no significant difference between mild sleepiness group and non-somnolence group. The ESS score of OSAHS patients with different degrees of mean oxygen saturation increased with the decrease of mean oxygen saturation. There was significant difference between moderate and severe hypoxic group and normal oxygen group (P 0.05). However, there was no significant difference in ESS score among OSAHS patients with different degrees of lowest oxygen saturation. The percentage of sleep time in stage S1 2 sleep increased with the increase of somnolence, and the sleep efficiency increased. The percentage of sleep time in S34 sleep decreased with the severity of somnolence. The ESS score was positively correlated with AHI,AI,HI,TS90, and the ESS score was negatively correlated with the average Sp0_2, sleep efficiency. After exclusion of confounding factors, somnolence was positively correlated with AHI,TS90 and negatively correlated with sleep efficiency. Poor correlation with sleep microarousal. Conclusion: EDS in patients with OSAHS has a close relationship with the nocturnal average of Sp0_2,TS90,S1 _ 2 and S _ 34 of lowest Sp02, in AHI,AI, and sleep efficiency is closely related. The higher the AHI, the more serious the hypoxemia, the longer the duration, the larger the proportion of shallow sleep, the smaller the proportion of deep sleep, the worse the sleep efficiency, and the more serious EDS in OSAHS patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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