背景 正常眼压性青光眼(NTG)是原发性开角型青光眼中的一个重要类型,非眼压依赖因素对本病的影响已受到广泛关注,而近期一些研究发现睡眠呼吸暂停综合征患者青光眼发病率较高,提示两者之间有一定的内在联系. 目的 探讨NTG患者睡眠呼吸事件的发生频率和强度及其与青光眼进展的关系.方法 采用前瞻性病例对照研究设计,纳入2011-2012年于北京大学第三医院眼科就诊的NTG患者20例作为NTG组,纳入同期年龄和性别匹配的18名健康志愿者作为正常对照组,所有受试者进行视野、海德堡共焦激光眼底断层扫描仪(HRT)检查、OCT检查以及多导睡眠监测(PSG),采用SPSS 17.0统计学软件对两组之间受试者的各睡眠呼吸参数测量值的差异进行Mann-Whitney U检验或独立样本t检验,对受试者睡眠呼吸事件参数测量值与平均视网膜神经纤维层(RNFL)厚度及视杯容积的关系进行Spearman秩相关分析和Pearson相关分析,确定NTG患者睡眠呼吸事件与青光眼相关指标的关系. 结果 两个组间受试者的临床基线特征,包括年龄、性别、身高、体质量及体质量指数(BMI)的差异均无统计学意义(P＞0.05).NTG组受试者测量的呼吸暂停低通气指数(AHI)、低通气指数(HI)和呼吸暂停指数(AI)均明显高于正常对照组,差异均有统计学意义(U=89.000,P=0.007;U=91.000,P=0.008；U=89.000,P=0.007),睡眠呼吸事件中关于时间的相关参数均明显长于正常对照组(P＜0.05),而睡眠觉醒期和睡眠中动脉血氧饱和度均低于正常对照组,差异均有统计学意义(t=-3.480,P=0.001；t=-3.255,P=0.002).两个组间受试者睡眠平均心率、睡眠最低心率、睡眠最高心率的差异均无统计学意义(t=-0.133,P=0.895;t=-0.906,P=0.371;t=-0.164,P=0.871).HRT测量的NTG患者平均RNFL厚度为(188.16±98.29) μm,与最低睡眠动脉血氧饱和度[(85.55±6.58)％]呈中度正相关(r=0.552,P=0.022),与AHI、AI均呈中度负相关(r=-0.530,P=0.019；r=-0.517,P=0.024),但HI与RNFL厚度无明显相关性(r=-0.399,P=0.091).OCT测量的NTG患者视杯容积为(0.580±0.215)μm3,与AHI、AI、HI均呈中度正相关(r=0.584,P=0.018;r=0.670,P=0.005；r=0.544,P=0.034),而与睡眠最低动脉血氧饱和度间无明显相关性(r=-0.493,P=0.052). 结论 NTG患者睡眠呼吸事件发生的概率及强度均较正常人增加,可能在一定程度上与NTG的发病有关,同时对NTG患者的神经修复过程有不良影响.
揹景 正常眼壓性青光眼(NTG)是原髮性開角型青光眼中的一箇重要類型,非眼壓依賴因素對本病的影響已受到廣汎關註,而近期一些研究髮現睡眠呼吸暫停綜閤徵患者青光眼髮病率較高,提示兩者之間有一定的內在聯繫. 目的 探討NTG患者睡眠呼吸事件的髮生頻率和彊度及其與青光眼進展的關繫.方法 採用前瞻性病例對照研究設計,納入2011-2012年于北京大學第三醫院眼科就診的NTG患者20例作為NTG組,納入同期年齡和性彆匹配的18名健康誌願者作為正常對照組,所有受試者進行視野、海德堡共焦激光眼底斷層掃描儀(HRT)檢查、OCT檢查以及多導睡眠鑑測(PSG),採用SPSS 17.0統計學軟件對兩組之間受試者的各睡眠呼吸參數測量值的差異進行Mann-Whitney U檢驗或獨立樣本t檢驗,對受試者睡眠呼吸事件參數測量值與平均視網膜神經纖維層(RNFL)厚度及視杯容積的關繫進行Spearman秩相關分析和Pearson相關分析,確定NTG患者睡眠呼吸事件與青光眼相關指標的關繫. 結果 兩箇組間受試者的臨床基線特徵,包括年齡、性彆、身高、體質量及體質量指數(BMI)的差異均無統計學意義(P＞0.05).NTG組受試者測量的呼吸暫停低通氣指數(AHI)、低通氣指數(HI)和呼吸暫停指數(AI)均明顯高于正常對照組,差異均有統計學意義(U=89.000,P=0.007;U=91.000,P=0.008；U=89.000,P=0.007),睡眠呼吸事件中關于時間的相關參數均明顯長于正常對照組(P＜0.05),而睡眠覺醒期和睡眠中動脈血氧飽和度均低于正常對照組,差異均有統計學意義(t=-3.480,P=0.001；t=-3.255,P=0.002).兩箇組間受試者睡眠平均心率、睡眠最低心率、睡眠最高心率的差異均無統計學意義(t=-0.133,P=0.895;t=-0.906,P=0.371;t=-0.164,P=0.871).HRT測量的NTG患者平均RNFL厚度為(188.16±98.29) μm,與最低睡眠動脈血氧飽和度[(85.55±6.58)％]呈中度正相關(r=0.552,P=0.022),與AHI、AI均呈中度負相關(r=-0.530,P=0.019；r=-0.517,P=0.024),但HI與RNFL厚度無明顯相關性(r=-0.399,P=0.091).OCT測量的NTG患者視杯容積為(0.580±0.215)μm3,與AHI、AI、HI均呈中度正相關(r=0.584,P=0.018;r=0.670,P=0.005；r=0.544,P=0.034),而與睡眠最低動脈血氧飽和度間無明顯相關性(r=-0.493,P=0.052). 結論 NTG患者睡眠呼吸事件髮生的概率及彊度均較正常人增加,可能在一定程度上與NTG的髮病有關,同時對NTG患者的神經脩複過程有不良影響.
배경 정상안압성청광안(NTG)시원발성개각형청광안중적일개중요류형,비안압의뢰인소대본병적영향이수도엄범관주,이근기일사연구발현수면호흡잠정종합정환자청광안발병솔교고,제시량자지간유일정적내재련계. 목적 탐토NTG환자수면호흡사건적발생빈솔화강도급기여청광안진전적관계.방법 채용전첨성병례대조연구설계,납입2011-2012년우북경대학제삼의원안과취진적NTG환자20례작위NTG조,납입동기년령화성별필배적18명건강지원자작위정상대조조,소유수시자진행시야、해덕보공초격광안저단층소묘의(HRT)검사、OCT검사이급다도수면감측(PSG),채용SPSS 17.0통계학연건대량조지간수시자적각수면호흡삼수측량치적차이진행Mann-Whitney U검험혹독립양본t검험,대수시자수면호흡사건삼수측량치여평균시망막신경섬유층(RNFL)후도급시배용적적관계진행Spearman질상관분석화Pearson상관분석,학정NTG환자수면호흡사건여청광안상관지표적관계. 결과 량개조간수시자적림상기선특정,포괄년령、성별、신고、체질량급체질량지수(BMI)적차이균무통계학의의(P＞0.05).NTG조수시자측량적호흡잠정저통기지수(AHI)、저통기지수(HI)화호흡잠정지수(AI)균명현고우정상대조조,차이균유통계학의의(U=89.000,P=0.007;U=91.000,P=0.008；U=89.000,P=0.007),수면호흡사건중관우시간적상관삼수균명현장우정상대조조(P＜0.05),이수면각성기화수면중동맥혈양포화도균저우정상대조조,차이균유통계학의의(t=-3.480,P=0.001；t=-3.255,P=0.002).량개조간수시자수면평균심솔、수면최저심솔、수면최고심솔적차이균무통계학의의(t=-0.133,P=0.895;t=-0.906,P=0.371;t=-0.164,P=0.871).HRT측량적NTG환자평균RNFL후도위(188.16±98.29) μm,여최저수면동맥혈양포화도[(85.55±6.58)％]정중도정상관(r=0.552,P=0.022),여AHI、AI균정중도부상관(r=-0.530,P=0.019；r=-0.517,P=0.024),단HI여RNFL후도무명현상관성(r=-0.399,P=0.091).OCT측량적NTG환자시배용적위(0.580±0.215)μm3,여AHI、AI、HI균정중도정상관(r=0.584,P=0.018;r=0.670,P=0.005；r=0.544,P=0.034),이여수면최저동맥혈양포화도간무명현상관성(r=-0.493,P=0.052). 결론 NTG환자수면호흡사건발생적개솔급강도균교정상인증가,가능재일정정도상여NTG적발병유관,동시대NTG환자적신경수복과정유불량영향.
Background Normal-tension glaucoma (NTG) is a common form of open-angle glaucoma throughout the world and additional intraocular pressure (IOP)-independent factors take increasing importance in NTG.Some recent studies found that patients with obstructive sleep apnea syndrome had a high prevalence of NTG.Objective The aim of this study was to determine the relationship between NTG and sleep-breathing events.Methods A prospective cases-controlled trial was designed.This trial protocol was approved by the Ethic Committee of Peking University Third Hospital.Written informed consent was obtained from each subject prior to entering into the study cohort.Twenty NTG patients were included in Peking University Third Hospital in 2011-2012,and 18 normal volunteers were enrolled in the same duration.Perimetry,retinal nerve fibrous layer (RNFL) thickness by Heidelberg confocal laser scanner (HRT),volume of optical disc by OCT and polysomnography (PSG) in night were performed on all the subjects.The difference of all the PSG sleep parameters were compared using Mann-Whitney U test or independent sample t test,and the correlations of PSG sleep parameters with RNFL and volume of optical disc in the NTG patients were analyzed by Spearman rank correlation and Pearson correlation analysis of SPSS 17.0 software.Results The demographic baseline of the subjects was no significant difference between the NTG group and the normal control group,including age,gender,height,weight and body mass index(BMI) (all at P＞0.05).Apnea hypopnea index (AHI),hypopnea index (HI) and apnea index (AI) were significantly higher(U=89.000,P =0.007; U=91.000,P=0.008; U=89.000,P=0.007),and the time-related parameters of apnea sleep events were longer in the NTG group than those in the normal control group (all at P＜0.05).In the NTG group,lowest sleep SaO2 of both waking and sleeping states was significant declined in comparison with the normal control group (t =-3.480,P =0.001 ; t =-3.255,P =0.002).The mean heart rate,lowest heart rate and highest heart rate in sleeping state were insignificantly differences between the two groups (t =-0.133,P =0.895 ; t =-0.906,P =0.371 ; t =-0.164,P =0.871).The mean RNFL thickness was (188.16±98.29)μm in the NTG group and showed a moderate positive correlation with the lowest sleep SaO2 of sleeping state ([85.55 ± 6.58] ％) (r =0.552,P =0.022) and moderate negative correlations with AHI,AI(r=-0.530,P=0.019; r=-0.517,P=0.024).No significant correlation was seen between the RNFL thickness and HI (r=-0.399,P=0.091).The volume of optical disk was (0.580±0.215) μm and presented moderate positive correlations with AHI,AI,HI (r =0.584,P =0.018 ; r =0.670,P =0.005 ; r =0.544,P =0.034).However,there was no significant correlation between volume of optical disk and the lowest sleep SaO2of sleeping state (r =-0.493,P =0.052).Conclusions The probability and intensity of sleep-breathing events have increasing trends in NTG patients,which probably is associated with the pathogenesis and advancement of NTG.The abnormality of PSG sleep parameters plays adverse effect on the repair process of optical nerve of NTG patients.
