Analysis of influencing factors and predictive indicators of obstructive sleep apnea combined with obesity-related sleep hypoventilation

doi:10.11958/20212745

Abstract

Abstract:

Objective To analyze the clinical characteristics and related influencing factors of obstructive sleep apnea (OSA) combined with obesity-related sleep hypoventilation (ORSH) and to identify indicators that can predict the OSA combined with ORSH population. Methods A total of 185 obese patients (body mass index ≥30 kg/m²) who were admitted to hospital due to snoring were selected. All patients underwent daytime awake arterial blood gas analysis, pulmonary function examination, polysomnography monitoring and percutaneous carbon dioxide monitoring at least 7 hours. According to the above examination results, patients were divided into the OSA group (n=109), the OSA combined with ORSH group (n=46) and the OSA combined with obesity hypopnea syndrome (OHS) group (n=30). The general clinical characteristics, pulmonary function, arterial blood gas and polysomnography monitoring indexes were compared and analyzed in the three groups. Multivariate Logistic regression analysis was conducted to analyze the risk factors of OSA combined with ORSH. A model was established and receiver operating characteristic (ROC) curve was drawn to analyze the prediction efficiency. Results Waist circumference, BMI and proportion of stroke patients were higher in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group, while the percentage of forced expiratory volume in the first second in the predicted value (FEV₁%) and the percentage of forced vital capacity in the predicted value (FVC%) were significantly lower in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group (P<0.05). Arterial partial pressure of oxygen [p(O₂)] was significantly lower in the OSA combined with OHS group than that in the OSA group, while arterial partial pressure of carbon dioxide [p(CO₂)] and bicarbonate ion (HCO₃^-) were significantly higher than those in the OSA group and the OSA combined with ORSH group (P<0.05). P(CO₂) and HCO₃^- were significantly higher in the OSA combined with ORSH group than those in the OSA group (P<0.05). Compared with the OSA group, the Epworth sleepiness scale score (ESS) was higher in the OSA combined with OHS group, and the oxygen reduction index (ODI), apnea hypopnea index (AHI), micro-arousal index (MAI), apnea index (AI), mean apnea time (MAT), longest apnea time (LAT), the percentage of time with blood oxygen saturation less than 90% of the total time (T90) and the treatment proportion of bi-level positive airway pressure (BI-PAP) ventilation mode were increased in the OSA combined with ORSH group and the OSA combined with OHS group, while the minimum oxygen saturation (minSpO₂) and mean blood oxygen saturation (meanSpO₂) decreased (P<0.05). Compared with the OSA combined with ORSH group, the proportion of continuous positive airway pressure (CPAP) treatment mode was decreased in the OSA combined with OHS group, and the proportion of BI-PAP ventilator treatment was increased (P<0.05). Multivariate Logistic regression analysis indicated that prolonged LAT and increased HCO₃^- were independent risk factors for OSA combined with ORSH. The area under the curve predicted by LAT and HCO₃^- was 0.784, the sensitivity was 0.913, and the specificity was 0.541. Conclusion The combined detection of LAT and HCO₃^- has a certain predictive value for OSA combined with ORSH.

Key words: obesity hypoventilation syndrome, sleep apnea syndrome, hypercapnia, carbon dioxide, blood gas analysis, longest apnea time

CLC Number:

R563.9

Figures/Tables 7

References 19

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组别	n	男性	年龄（岁）	颈围（cm）	腰围（cm）	BMI（kg/m²）	吸烟史	饮酒史	高血压	冠心病	糖尿病	脑卒中
单纯OSA组	109	77（70.6）	45.3±12.3	43.8±7.6	111.2±10.8	33.6±3.1	38（34.8）	44（40.3）	59（54.1）	15（13.8）	25（22.9）	4（3.6）
OSA合并ORSH组	46	39（84.7）	42.4±14.4	43.8±2.9	115.5±11.3	34.6±4.9	18（39.1）	18（39.1）	21（45.6）	7（15.2）	11（23.9）	2（4.3）
OSA合并OHS组	30	19（70.3）	49.3±11.9	45.8±3.6	122.7±15.0^ab	36.8±6.2^ab	14（46.6）	13（43.3）	18（60.0）	5（16.6）	7（23.3）	5（16.6）^ab
χ²或F		4.967	2.626	1.273	6.340^＊＊	6.713^＊＊	1.437	0.136	1.619	0.178	0.017	7.385^＊

组别	n	男性	年龄（岁）	颈围（cm）	腰围（cm）	BMI（kg/m²）	吸烟史	饮酒史	高血压	冠心病	糖尿病	脑卒中
单纯OSA组	109	77（70.6）	45.3±12.3	43.8±7.6	111.2±10.8	33.6±3.1	38（34.8）	44（40.3）	59（54.1）	15（13.8）	25（22.9）	4（3.6）
OSA合并ORSH组	46	39（84.7）	42.4±14.4	43.8±2.9	115.5±11.3	34.6±4.9	18（39.1）	18（39.1）	21（45.6）	7（15.2）	11（23.9）	2（4.3）
OSA合并OHS组	30	19（70.3）	49.3±11.9	45.8±3.6	122.7±15.0^ab	36.8±6.2^ab	14（46.6）	13（43.3）	18（60.0）	5（16.6）	7（23.3）	5（16.6）^ab
χ²或F		4.967	2.626	1.273	6.340^＊＊	6.713^＊＊	1.437	0.136	1.619	0.178	0.017	7.385^＊

组别		n	pH值		p（O₂）（mmHg）
单纯OSA组		109	7.41±0.02		75.43±9.24
OSA合并ORSH组		46	7.41±0.02		73.20±7.82
OSA合并OHS组		30	7.39±0.03		68.90±8.51^a
F			5.477		6.567^＊＊
组别	p（CO₂）（mmHg）			HCO₃^-（mmol/L）
单纯OSA组	39.86±2.89			24.53±1.87
OSA合并ORSH组	41.57±2.34^a			25.60±1.67^a
OSA合并OHS组	50.60±10.24^ab			31.86±12.42^ab
F	59.296^＊＊			23.261^＊＊

组别		n	pH值		p（O₂）（mmHg）
单纯OSA组		109	7.41±0.02		75.43±9.24
OSA合并ORSH组		46	7.41±0.02		73.20±7.82
OSA合并OHS组		30	7.39±0.03		68.90±8.51^a
F			5.477		6.567^＊＊
组别	p（CO₂）（mmHg）			HCO₃^-（mmol/L）
单纯OSA组	39.86±2.89			24.53±1.87
OSA合并ORSH组	41.57±2.34^a			25.60±1.67^a
OSA合并OHS组	50.60±10.24^ab			31.86±12.42^ab
F	59.296^＊＊			23.261^＊＊

组别	n	FVC%	FEV₁%
单纯OSA组	109	95.9±14.5	93.8±13.9
OSA合并ORSH组	46	93.4±13.2	91.5±13.8
OSA合并OHS组	30	80.3±18.4^ab	79.7±21.0^ab
F		12.915^＊＊	10.085^＊＊