CAJ | 학술논문

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与胃食管反流(gastroesophageal reflux,GER)的关系.方法 76例OSAHS患者行多道睡眠监测及夜间远端食管pH监测.评估OSAHS患者GER的发生率.对其中32例合并GER并适宜手术的OSAHS患者行悬雍垂腭咽成形术等手术治疗,术后6个月复查多道睡眠监测及远端食管pH值,对比术前、术后呼吸暂停低通气指数(AHI)、微觉醒指数(micro-arousal index,MAI)、最低动脉血氧饱和度(lowest SaO2,LSaO2)、远端食管酸化指数(pH index,pHI)及食管酸暴露时间(acid contact time,ACT)百分比,并进行相关性分析.结果 76例OSAHS患者AHI为(38.6±29.5)次/h(x±s,下同),伴发GER 48例(占63.2%).32例合并GER的OSAHS患者术前及术后6个月AHI分别为(51.2±23.1)和(17.3±10.3)次/h;MAI为(38.3±21.4)和(14.5±10.0)次/h;LSaO2为(0.698±0.107)和(0.858±0.076);pHI为(12.5±6.6)和(6.3±4.2)次/h;ACT百分比为(10.3±5.2)%和(4.5±2.9)%,配对t检验差异均有统计学意义(t值分别为10.95、7.82、15.97、6.12、7.62,P值均<0.001).术后较术前AHI、MAI减少值与pHI的减少存在相关性(r值分别为0.775和0.764,P值均<0.001);AHI、MAI改善程度与ACT百分比减少存在相关性(r值分别为0.607和0.730,P值均<0.001).结论 OSAHS患者较易发生夜间GER,对OSAHS的治疗在显著降低AHI、MAI的同时也明显改善了GER,提示夜间胃食管反流的发生与呼吸及睡眠紊乱有关.
목적 연구조새성수면호흡잠정저통기종합정(OSAHS)여위식관반류(gastroesophageal reflux,GER)적관계.방법 76례OSAHS환자행다도수면감측급야간원단식관pH감측.평고OSAHS환자GER적발생솔.대기중32례합병GER병괄의수술적OSAHS환자행현옹수악인성형술등수술치료,술후6개월복사다도수면감측급원단식관pH치,대비술전、술후호흡잠정저통기지수(AHI)、미각성지수(micro-arousal index,MAI)、최저동맥혈양포화도(lowest SaO2,LSaO2)、원단식관산화지수(pH index,pHI)급식관산폭로시간(acid contact time,ACT)백분비,병진행상관성분석.결과 76례OSAHS환자AHI위(38.6±29.5)차/h(x±s,하동),반발GER 48례(점63.2%).32례합병GER적OSAHS환자술전급술후6개월AHI분별위(51.2±23.1)화(17.3±10.3)차/h;MAI위(38.3±21.4)화(14.5±10.0)차/h;LSaO2위(0.698±0.107)화(0.858±0.076);pHI위(12.5±6.6)화(6.3±4.2)차/h;ACT백분비위(10.3±5.2)%화(4.5±2.9)%,배대t검험차이균유통계학의의(t치분별위10.95、7.82、15.97、6.12、7.62,P치균<0.001).술후교술전AHI、MAI감소치여pHI적감소존재상관성(r치분별위0.775화0.764,P치균<0.001);AHI、MAI개선정도여ACT백분비감소존재상관성(r치분별위0.607화0.730,P치균<0.001).결론 OSAHS환자교역발생야간GER,대OSAHS적치료재현저강저AHI、MAI적동시야명현개선료GER,제시야간위식관반류적발생여호흡급수면문란유관.
Objective To study the relationship between obstructive sleep apnea and nocturnal gastroesophageal reflux (GER). Methods Seventy-six patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent polysomnography (PSG) and nocturnal distal esophageal pH monitoring, to assess the prevalence of GER in OSAHS patients. Among these patients, thirty-two OSAHS patients with GER disease had been operated on. Surgical treatment included uvulopalatopharyngoplasty (UPPP), inferior turbinate reduction, nasal septoplasty et al. After 6 months of surgical treatment, the PSG and pH probe testing were rechecked. The pre and post operative apnea-hypopnea index (AHI), micro-arousal index (MAI), lowest artery oxygensaturation (LSaO2), acidified index of distal esophagus (pHI) and percentage of acid contact time of esophagus were compared. The correlation analysis was also employed. Results The AHI of 76 OSAHS patients was (38.6±29.5)/h (x±s), GER was present in 48 patients (63.2%). The pre and post operative AHI, MAI, LSaO2, pHI and percentage of ACT in 32 OSAHS patients associated with GER were (51.2±23.1)/h and (17.3±10.3)/h, (38.3±21.4)/h and (14.5±10.0)/h, 0.698±0.107 and 0.858±0.076, (12.5±6.6)/h and (6.3±4.2)/h, (10.3±5.2)% and (4.5± 2.9)%. The differences were statistically significant by matching t test (t were 10.95, 7.82, 15.97, 6.12, 7.62 respectively, P <0.001). There were positive relationships between the reductions of AHI, MAI and the reductions of pHI (r were 0.775, 0.764, P<0.001). The improved levels of AHI and MAI were correlated with the reduction of the percentage of ACT (r were 0.607, 0.730, P<0.001). Conclusions GER is prevalent in OSAHS patients. Surgical treatment of OSAHS has significant reduction in AHI, MAI as well as marked improvement in the GER, which suggests that nocturnal gastroesophageal reflux is correlated with the disorder of sleep respiration and the sleep disturbances.