CAJ | 학술논문

目的探讨不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠障碍和夜间缺氧的发生特点和影响因素.方法对425例打鼾患者应用Epworth嗜睡量表进行问卷调查,计算嗜睡评分;用多导睡眠监测仪(PSG)进行整夜睡眠监测,分析患者睡眠结构和夜间反复低氧的特点与嗜睡评分及临床症状之间的相关性.结果按呼吸暂停低通气指数(AHI)将425例患者分为单纯鼾症组65例(15.3%);OSAHS患者360例(84.7%),其中轻度OSAHS组96例(22.6%),中度OSAHS组77例(18.1%),重度OSAHS组187例(44.O%).OSAHS患者随着病情加重,嗜睡评分明显升高,组间比较差异均有统计学意义.OSAHS患者与单纯鼾症组比较,睡眠效率、非快速眼球运动1和2期(NREMl+2)睡眠时间增长,3和4期(NREM3+4)睡眠时间缩短;氧减指数(ODI)、脉搏氧饱和度低于90%的时间[T(SpO2<90%)]增高,最低脉搏氧饱和度(LSpO2)降低.随着OSAHS病情加重,各指标变化越大.相关分析提示,嗜睡评分与AHI呈正相关(r=0.474,P<0.01),两者与ODI、T(SpO2<90%)及NREMl+2睡眠时间呈正相关(嗜睡评分r=0.392、0.356、0.194,AHI r=0.714、0.682、0.365;均P<0.01),与LSpO2和NREM3+4睡眠时间呈负相关(嗜睡评分r=-0.414、-0.196,AHI r=-0.740、-0.385;均P<0.01),其中LSp02、ODI、T(SpO2<90%)为主要影响因素.临床上患者出现白天嗜睡、记忆力下降、疲乏、口于、夜间憋醒、晨起头痛等主要症状,重度患者白天嗜睡症状的发生率达73.3%(137/187).结论不同程度OSAHS患者均存在睡眠障碍,患者嗜睡的严重程度与睡眠结构的改变部分相关,而与缺氧情况呈明显相关.随着疾病严重程度的加重,睡眠障碍和缺氧越明显,嗜睡评分越高.
목적 탐토불동정도조새성수면호흡잠정저통기종합정(OSAHS)환자수면장애화야간결양적발생특점화영향인소.방법 대425례타한환자응용Epworth기수량표진행문권조사,계산기수평분;용다도수면감측의(PSG)진행정야수면감측,분석환자수면결구화야간반복저양적특점여기수평분급림상증상지간적상관성.결과 안호흡잠정저통기지수(AHI)장425례환자분위단순한증조65례(15.3%);OSAHS환자360례(84.7%),기중경도OSAHS조96례(22.6%),중도OSAHS조77례(18.1%),중도OSAHS조187례(44.O%).OSAHS환자수착병정가중,기수평분명현승고,조간비교차이균유통계학의의.OSAHS환자여단순한증조비교,수면효솔、비쾌속안구운동1화2기(NREMl+2)수면시간증장,3화4기(NREM3+4)수면시간축단;양감지수(ODI)、맥박양포화도저우90%적시간[T(SpO2<90%)]증고,최저맥박양포화도(LSpO2)강저.수착OSAHS병정가중,각지표변화월대.상관분석제시,기수평분여AHI정정상관(r=0.474,P<0.01),량자여ODI、T(SpO2<90%)급NREMl+2수면시간정정상관(기수평분r=0.392、0.356、0.194,AHI r=0.714、0.682、0.365;균P<0.01),여LSpO2화NREM3+4수면시간정부상관(기수평분r=-0.414、-0.196,AHI r=-0.740、-0.385;균P<0.01),기중LSp02、ODI、T(SpO2<90%)위주요영향인소.림상상환자출현백천기수、기억력하강、피핍、구우、야간별성、신기두통등주요증상,중도환자백천기수증상적발생솔체73.3%(137/187).결론 불동정도OSAHS환자균존재수면장애,환자기수적엄중정도여수면결구적개변부분상관,이여결양정황정명현상관.수착질병엄중정도적가중,수면장애화결양월명현,기수평분월고.
Objective To analyze the characteristics and influencing factors of sleep disorders and nocturnal hypoxemia of patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Four hundred and twenty-five patients with snoring were scored by Epworth Sleepiness Scale ( ESS), and monitored by polysomnography (PSG). The possible correlations between sleep structure, hypoxia parameters, ESS and clinical features were analyzed and compared in those patients. Results Four hundred and twenty-five patients were divided into 4 groups according to the apnea-hypopnea index (AHI). There were 65 primary snoring patients (15.3%) and 360 OSAHS patients (84. 7% ) including 187 patients (44. 0% ) in severe OSAHS group. ESS was increased as aggravation of OSAHS. There were significant statistical differences in ESS among each group. Compared with primary snoring group, sleep efficiency, NREM1 + 2, oxygen desaturation index ( ODI), time with pulse oxygen saturation below 90% (T(SpO2 <90% ) ) were significantly higher in the OSAHS groups, and NREM3 +4, lowest pulse oxygen saturation level ( LSpO2 ) were lower. ESS was correlated positively with AHI (r= 0. 474,P <0. 01 ). They were both correlated positively with ODI, T (SpO2 <90% ) and NREM1 + 2( ESSr =0. 392, 0. 356,0. 194;AHI r = 0. 714, O. 682, 0. 365, all P < 0. 01 ), and correlated negatively with LSpO2, NREM3 + 4 ( ESS r = - 0. 414, - 0. 196; AHI r = - 0. 740, - 0. 385, both P < 0. 01 ). LSpO2, ODI and T (SpO2 < 90% ) were the primary influencing factors. Common clinical presentations and subjective symptoms were presented including daytime sleepiness, impaired memory, fatigue, dry mouth, oppressive wake and morning headache, etc. Percentage of individuals with daytime sleepiness in the severe OSAHS group was 73. 3% (137/187). These had serious impact on the patients' quality of life, leading to difficulty concentrating, poor memory and cognitive impairment. Conclusions Sleep disorders are found in the patients with different degrees of OSAHS. The excessive daytime sleepiness interrelated partly with the structure of sleep, and totally with hypoxia parameters. The more severity the patients have, the more nocturnal hypoxia, sleep disorders and higher ESS are found.