中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
10期
803-806
,共4页
邵川%励雯静%李善群%吴晓丹%周敬%鲁沈源%钮善福%白春学
邵川%勵雯靜%李善群%吳曉丹%週敬%魯瀋源%鈕善福%白春學
소천%려문정%리선군%오효단%주경%로침원%뉴선복%백춘학
睡眠呼吸暂停,阻塞性%呼吸障碍%低氧血症
睡眠呼吸暫停,阻塞性%呼吸障礙%低氧血癥
수면호흡잠정,조새성%호흡장애%저양혈증
Sleep apnea,obstructive%Respiratory disorders%Anpoxia
目的 加深对老年患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)特点的认识,提高老年OSAHS诊治水平.方法 对我院睡眠呼吸障碍与鼾症诊治中心诊断的110例老年OSAHS患者的整夜多导睡眠图(PSG)监测资料进行回顾性分析,应用SPSS 18.0统计软件对患者的一般情况、睡眠结构、呼吸暂停和低通气情况、氧减饱和情况以及各指标间可能的相关关系进行统计分析.结果老年OSAHS患者中位快动眼相(rapid eye movement,REM)和非快动眼相(NREM)睡眠时间分别占2.17%和76.73%;中位觉醒指数为45.60次/h.呼吸暂停最长时间为(51.94±22.06)s,中位呼吸暂停平均时间为22.50 s,低通气最长时间为(47.06±12.52)s,低通气平均时间为(21.50±4.63)s.中位呼吸紊乱指数(respiratory disturbance index,RD1)为21.50,RDI 5～20者占46.40%,20～40者占31.80%,＞40者占21.80%.夜间平均血氧饱和度为(93.45±2.81)%,夜间最低血氧饱和度为(76.30±10.50)%,中位氧减饱和指数为31.65次/h.体质指数(BMI)与夜间最低血氧饱和度(r=-0.378,P＜0.01)和夜间平均血氧饱和度(r=-0.355,P＜0.01)呈负相关,与氧减指数呈正相关(r=0.338,P＜0.01);夜间最低血氧饱和度与阻塞性呼吸暂停最长时间(r=-0.47,P＜0.01)、阻塞性呼吸暂停平均时间(r=-0.31 6,P＜0.01)、低通气最长时间(r=-0.293,P＜0.01)和低通气平均时间(r=-0.277,P＜0.01)呈负相关.仰卧位睡眠时中位氧减时间间隔为2.36 min,左侧卧位睡眠时中位氧减时间间隔为11.54 min,右侧卧位睡眠时中位氧减时间间隔为12.45 min,左侧卧位和右侧卧位睡眠时中位氧减时间间隔均长于仰卧位(Z值分别为-6.12和-7.10,均P＜0.01).结论 老年OSAHS患者存在明显的睡眠结构紊乱和睡眠片段化.依据RDI对患者的病情分级,大多数OSAHS患者为轻、中度,但缺氧程度较重,缺氧严重度与BMI和睡眠呼吸事件的持续时间相关,侧卧睡眠时缺氧程度减轻.
目的 加深對老年患者阻塞性睡眠呼吸暫停低通氣綜閤徵(obstructive sleep apneahypopnea syndrome,OSAHS)特點的認識,提高老年OSAHS診治水平.方法 對我院睡眠呼吸障礙與鼾癥診治中心診斷的110例老年OSAHS患者的整夜多導睡眠圖(PSG)鑑測資料進行迴顧性分析,應用SPSS 18.0統計軟件對患者的一般情況、睡眠結構、呼吸暫停和低通氣情況、氧減飽和情況以及各指標間可能的相關關繫進行統計分析.結果老年OSAHS患者中位快動眼相(rapid eye movement,REM)和非快動眼相(NREM)睡眠時間分彆佔2.17%和76.73%;中位覺醒指數為45.60次/h.呼吸暫停最長時間為(51.94±22.06)s,中位呼吸暫停平均時間為22.50 s,低通氣最長時間為(47.06±12.52)s,低通氣平均時間為(21.50±4.63)s.中位呼吸紊亂指數(respiratory disturbance index,RD1)為21.50,RDI 5～20者佔46.40%,20～40者佔31.80%,＞40者佔21.80%.夜間平均血氧飽和度為(93.45±2.81)%,夜間最低血氧飽和度為(76.30±10.50)%,中位氧減飽和指數為31.65次/h.體質指數(BMI)與夜間最低血氧飽和度(r=-0.378,P＜0.01)和夜間平均血氧飽和度(r=-0.355,P＜0.01)呈負相關,與氧減指數呈正相關(r=0.338,P＜0.01);夜間最低血氧飽和度與阻塞性呼吸暫停最長時間(r=-0.47,P＜0.01)、阻塞性呼吸暫停平均時間(r=-0.31 6,P＜0.01)、低通氣最長時間(r=-0.293,P＜0.01)和低通氣平均時間(r=-0.277,P＜0.01)呈負相關.仰臥位睡眠時中位氧減時間間隔為2.36 min,左側臥位睡眠時中位氧減時間間隔為11.54 min,右側臥位睡眠時中位氧減時間間隔為12.45 min,左側臥位和右側臥位睡眠時中位氧減時間間隔均長于仰臥位(Z值分彆為-6.12和-7.10,均P＜0.01).結論 老年OSAHS患者存在明顯的睡眠結構紊亂和睡眠片段化.依據RDI對患者的病情分級,大多數OSAHS患者為輕、中度,但缺氧程度較重,缺氧嚴重度與BMI和睡眠呼吸事件的持續時間相關,側臥睡眠時缺氧程度減輕.
목적 가심대노년환자조새성수면호흡잠정저통기종합정(obstructive sleep apneahypopnea syndrome,OSAHS)특점적인식,제고노년OSAHS진치수평.방법 대아원수면호흡장애여한증진치중심진단적110례노년OSAHS환자적정야다도수면도(PSG)감측자료진행회고성분석,응용SPSS 18.0통계연건대환자적일반정황、수면결구、호흡잠정화저통기정황、양감포화정황이급각지표간가능적상관관계진행통계분석.결과노년OSAHS환자중위쾌동안상(rapid eye movement,REM)화비쾌동안상(NREM)수면시간분별점2.17%화76.73%;중위각성지수위45.60차/h.호흡잠정최장시간위(51.94±22.06)s,중위호흡잠정평균시간위22.50 s,저통기최장시간위(47.06±12.52)s,저통기평균시간위(21.50±4.63)s.중위호흡문란지수(respiratory disturbance index,RD1)위21.50,RDI 5～20자점46.40%,20～40자점31.80%,＞40자점21.80%.야간평균혈양포화도위(93.45±2.81)%,야간최저혈양포화도위(76.30±10.50)%,중위양감포화지수위31.65차/h.체질지수(BMI)여야간최저혈양포화도(r=-0.378,P＜0.01)화야간평균혈양포화도(r=-0.355,P＜0.01)정부상관,여양감지수정정상관(r=0.338,P＜0.01);야간최저혈양포화도여조새성호흡잠정최장시간(r=-0.47,P＜0.01)、조새성호흡잠정평균시간(r=-0.31 6,P＜0.01)、저통기최장시간(r=-0.293,P＜0.01)화저통기평균시간(r=-0.277,P＜0.01)정부상관.앙와위수면시중위양감시간간격위2.36 min,좌측와위수면시중위양감시간간격위11.54 min,우측와위수면시중위양감시간간격위12.45 min,좌측와위화우측와위수면시중위양감시간간격균장우앙와위(Z치분별위-6.12화-7.10,균P＜0.01).결론 노년OSAHS환자존재명현적수면결구문란화수면편단화.의거RDI대환자적병정분급,대다수OSAHS환자위경、중도,단결양정도교중,결양엄중도여BMI화수면호흡사건적지속시간상관,측와수면시결양정도감경.
Objective To improve the understanding of the characteristics of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the elderly patients, and to improve the diagnosis and treatment level. Methods Monitoring results of polysomnography (PSG) from 110 elderly OSAHS patients were analyzed retrospectively. The general conditions, sleep architecture, apnea and hypopnea events, oxygen reduction as well as possible correlations between various indicators were analyzed using SPSS18.0 statistical software. Results The median rapid eye movement (REM) and non-REM (NREM) sleep time of elderly patients with OSAHS accounted for 2. 17% and 76.73%,respectively. The median arousal index was 45.6 times/h. The longest time of sleep apnea was (51.94±22.06) s, the median of average sleep apnea time was 22.50 s, the longest time of hypopnea was (47.06±12.52) s and the average hypopnca time was (21.50±4.63) s. The median respiratory disturbance index (RDI) of all patients was 21.50, the patients with RDI between 5 and 20 accounted for 46.40%, with RDI between 20 and 40 accounted for 31.80% and with RDI over 40 accounted for 21.8%. The average oxygen saturation accounted for (93.45% ± 2.81%), the lowest oxygen saturation accounted for (76.3%± 10. 5%) and the median oxygen desaturation index was 31.6;times/h. BMI was negatively correlated with lowest oxygen saturation (r=-0. 378, P＜0.01) and average oxygen saturation ( r = - 0. 355, P ＜ 0. 01 ), while was positively correlated with oxygen desaturation index (r=0. 338, P＜0. 01 ). The lowest oxygen saturation was negatively correlated with the longest time of obstructive apnea (r= -0. 47, P＜0. 01 ), the average time of obstructive apnea (r=-0.316, P＜0.01), the longest time of hypopnea (r=-0.293, P＜0.01) and the average time of hypopnea (r=-0. 277, P＜0.01). The median time intervals of oxygen desaturation during supine, left side and right side position were 2.36 min, 11.54 min and 12.45 min,respectively. The median time intervals of oxygen desaturation during left side and right side position were both longer than that of supine position (Z= -6.12 and -7. 10 respectively, both P＜0.01).Conclusions Elderly patients with OSAHS manifest obvious disorder of sleep structural and sleep fragmentation. According to RDI, the majority of the patients are classified as mild to moderate in severity. However, elderly patients with OSAHS are severe regarding to hypoxia relatively. The severity of hypoxia is related with BMI and the lasting time of sleep-disordered breathing events, and hypoxia are less severe when sleeping on left side or on right side.
