天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1292-1296.doi: 10.11958/20170868

• 临床研究 • 上一篇    下一篇

睡眠低通气在阻塞性睡眠呼吸暂停低通气综合征中的 特点及影响因素分析

侯万举， 王彦， 董丽霞△， 曹洁△   

  1. 基金项目： 国家自然科学基金资助项目 （8167010263） 作者单位： 天津医科大学总医院呼吸科 （邮编 300052） 作者简介： 侯万举 （1981）， 男， 硕士在读， 主要从事慢性阻塞性肺疾病及睡眠障碍性疾病研究 △通讯作者 董丽霞 E-mail: Luckydonglixia@163.com； 曹洁 E-mail: tjcaojie@sina.com
  • 收稿日期:2017-08-04 修回日期:2017-10-20 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 侯万举 E-mail:houwanju@163.com
  • 基金资助:
    国家自然科学基金资助项目

Clinical features and related risk factors of sleep hypopnea in obstructive sleep apnea hypoventilation syndrome

HOU Wan-ju, WANG Yan, DONG Li-xia△, CAO Jie△   

  1. Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China △Corresponding Author DONG Li-xia E-mail: Luckydonglixia@163.com; CAO Jie E-mail: tjcaojie@sina.com
  • Received:2017-08-04 Revised:2017-10-20 Published:2017-12-15 Online:2017-12-15
  • Contact: Wan-Ju HOU E-mail:houwanju@163.com

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摘要： 目的 研究睡眠低通气（SH）在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者中的临床特点及相关影 响因素。方法 选取经行多导睡眠监测 （PSG） 同时联合经皮二氧化碳分压 （TCPCO2） 监测确诊的 OSAHS 患者 63 例。 按睡眠低通气诊断标准， 将研究对象分为 OSAHS 合并 SH 组 （n=28） 和单纯 OSAHS 组 （n=35）， 对比分析 2 组一般临 床特征， 包括性别、 年龄、 合并症、 体质量指数（BMI）、 Epworth 嗜睡量表（ESS）、 微觉醒指数、 动脉血气分析、 PSG 及 TCPCO2数据。最高 TcPCO2与各变量相关性采用 Pearson 相关和 Spearman 相关进行分析。最高 TcPCO2的影响因素 采用多重线性回归分析。ROC 曲线下面积分析相关变量诊断 SH 的价值。结果 全部 63 例 OSAHS 患者中， 确诊 SH 28 例， 比例为 44.4%。2 组性别、 年龄、 吸烟比例差异均无统计学意义。OSAHS 合并 SH 组 BMI、 动脉血二氧化碳 分压[p （CO2） ]、 高血压患者比例、 ESS、 睡眠呼吸暂停低通气指数、 微觉醒指数、 血氧饱和度小于 90% 时间占监测时间 百分比、 最高 TcPCO2、 各睡眠分期 TcPCO2均高于单纯 OSAHS 组（P＜0.05）， 而 pH 值、 动脉血氧分压[p（O2） ]、 最低脉 搏血氧饱和度（SPO2）低于单纯 OSAHS 组（P＜0.05）。最高 TcPCO2与 p（CO2）、 ESS、 BMI 呈显著正相关（P＜0.01）， 多 重线性回归分析显示最高 TcPCO2 受 BMI 和 ESS 影响。BMI 最佳临界值为 31.43 kg/m2 时诊断 SH 的敏感度为 64.3%， 特异度为 91.4%； 而 ESS 最佳临界值为 12 分时敏感度为 78.6%， 特异度为 71.4%。结论 OSAHS 合并 SH 存 在更加严重的夜间高 CO2 和低氧状态， 对 BMI 大于 31.43 kg/m2 及 ESS 大于 12 分的 OSHAS 患者， 建议行夜间 TCPCO2监测。

关键词: 睡眠呼吸暂停, 阻塞性, 多导睡眠监测, 经皮二氧化碳分压, 睡眠低通气, 肥胖

Abstract: Objective To analyze the clinical features and related risk factors of sleep hypopnea (SH) in obstructive sleep apnea hypoventilation syndrome (OSAHS). Methods A total of 63 patients with OSAHS who were underwent polysomnography (PSG) and transcutaneous carbon dioxide partial pressure (TCPCO2) monitoring were selected in this study. All patients were divided into pure OSAHS group (n=35) and OSAHS with SH group (n=28) according to the diagnostic criteria of SH. The clinical features of nocturnal carbon dioxide and related risk factors were compared between two groups, including gender, age, complications, body mass index (BMI), Epworth sleepiness scale (ESS), micro awakening index, arterial blood gas analysis, PSG and TCPCO2. Correlation analysis were used to analyze the correlation between the highest TCPCO2 and other variables. The influencing factors of the highest TCPCO2 were analyzed by multiple linear regression analysis. Receiver operating characteristic (ROC) curve analysis was used to analyze the value for related variables in the diagnosis of SH. Results Twenty-eight patients were diagnosed as SH in all the 63 patients with OSAHS, the proportion was 44.4%. There were no significant differences in gender, age and smoking proportion between the two groups. Data of BMI, arterial carbon dioxide partial pressure [p(CO2)], prevalence of hypertension, ESS, apnea hypopnea index, micro arousal index, percentage of nighttime sleep with blood oxygen saturation less than 90%, highest TCPCO2 and TCPCO2 during each sleep stage were significantly higher in the OSAHS with SH group than those in the pure OSAHS group (P＜0.05), while arterial oxygen partial pressure [p(O2)] and the lowest pulse oxygen saturation (SpO2) were significantly lower than those in pure OSAHS group (P＜0.05). The highest TCPCO2 was positively correlated with p(CO2), ESS and BMI (P＜0.01). Multiple linear regression analysis showed that the highest TCPCO2 was affected by BMI and ESS. As a possible predictor for OSAHS with SH, BMI >31.43 kg/m2 showed a sensitivity of 64.3% and specificity of 91.4%, and ESS score >12 showed a sensitivity of 78.6% and specificity of 71.4%. Conclusion The patients of OSAHS with SH have more severe nocturnal hypercapnia and hypoxemia. OSHAS patients are recommend to undergo TcPCO2 monitoring, when BMI is greater than 31.43 kg/m2 and ESS is greater than 12 scores.

Key words: sleep apnea, obstructive, polysomnography, transcutaneous carbon dioxide partial pressure, sleep hypoventilation, obesity