快动眼期呼吸暂停低通气指数在轻度阻塞性睡眠呼吸暂停低通气综合征病情评估中的意义

翟曜耀; 刘晓霞; 孟婵; 吴大海; 李树华

doi:10.16766/j.cnki.issn.1674-4152.002758

快动眼期呼吸暂停低通气指数在轻度阻塞性睡眠呼吸暂停低通气综合征病情评估中的意义

doi: 10.16766/j.cnki.issn.1674-4152.002758

1.
中国人民解放军北部战区总医院耳鼻咽喉头颈外科, 辽宁沈阳 110015
2.
中国医科大学附属盛京医院放射科, 辽宁沈阳 110004

基金项目:

辽宁省科技攻关计划项目 2020JH2/10300171

详细信息

通讯作者:
李树华，E-mail：627745272@qq.com

中图分类号: R766.3
计量
- 文章访问数: 214
- HTML全文浏览量: 121
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-13
- 网络出版日期: 2023-02-07

Significance of rapid-eye-movement apnoea-hypopnea index for the evaluation of the mild obstructive sleep apnoea-hypopnea syndrome

1.
Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110015, China

摘要

摘要: 目的选取多导睡眠呼吸监测(polysomnogram, PSG)中评价轻度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)患者病情轻重的合适指标，并探讨其对轻度OSAHS患者病情评估的意义。方法收集2016年1月—2020年12月就诊于中国人民解放军北部战区总医院耳鼻咽喉头颈外科经PSG检查符合轻度OSAHS的患者共166例，分别记录PSG各项指标及爱泼沃斯嗜睡量表(Epworth sleepiness score, ESS)、匹茨堡睡眠质量指数量表(Pittsburgh sleep quality index, PSQI)、蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)评分，分析PSG中各项指标与各量表评分的相关性，并选取相关性强的指标进行相应的分组分析。结果 ESS评分与快动眼期呼吸暂停低通气指数(rapid-eye-movement apnea-hypopnea index, REM-AHI)在2种相关性检验中均呈正相关关系(r=0.248、0.192，均P < 0.05)；MoCA评分与REM-AHI在2种相关性检验中均呈负相关关系(r=-0.260、-0.201，均P < 0.05)。REM-AHI分组中各组间ESS评分、PSQI评分、MoCA评分比较差异均有统计学意义(均P < 0.05)；而最低血氧饱和度(lowest saturation oxygen, LSO₂)分组中各组间ESS评分、PSQI评分、MoCA评分比较差异均无统计学意义(均P>0.05)。结论 REM-AHI作为评估轻度OSAHS患者病情轻重的指标有着比LSO₂等指标更为重要的意义，尤其是REM-AHI呈现中、重度的患者，其对机体的损害高于一般的轻度OSAHS患者。
- 阻塞性睡眠呼吸暂停低通气综合征 /
- 轻度 /
- 快动眼期呼吸暂停低通气指数
Abstract: Objective To select the appropriate index in polysomnogram (PSG) to evaluate the severity of patients with mild obstructive sleep apnoea-hypopnea syndrome (OSAHS) and explore its significance in evaluating the patients with mild OSAHS. Methods A total of 166 patients with mild OSAHS from General Hospital of Northern Theater Command from January 2016 to December 2020 were examined by PSG. Every index in the PSG and the results of Epworth sleepiness score (ESS), Pittsburgh sleep quality index (PSQI) and Montreal cognitive assessment (MoCA) were recorded, and the correlation between them was analysed. Strong relevance indexes were selected, and the groups were compared based on the index values. Results The correlation between ESS and rapid-eye-movement apnoea-hypopnea index (REM-AHI) was positive in the two correlation tests (r=0.248, 0.192, both P < 0.05), and that between the MoCA score and REM-AHI was negative (r=-0.260, -0.201, both P < 0.05). The comparison of ESS, PSQI and MoCA results among the REM-AHI groups were all statistically significant (all P < 0.05), but the comparison among the lowest-saturation-oxygen (LSO₂) groups showed no statistically significant results (all P>0.05). Conclusion REM-AHI is more meaningful for the evaluation of the severity of mild OSAHS than other indexes such as LSO₂. In particular, mild OSAHS patients with moderate-to-severe REM-AHI suffer from more damage to their bodies than the general ones.
- Obstructive sleep apnoea-hypopnea syndrome /
- Mild /
- Rapid-eye-movement apnoea-hypopnea index

HTML全文

表 1 PSG各指标与3个量表评分的相关性分析

项目	ESS评分				PSQI评分				MoCA评分
项目	r值^a	P值^a	r值^b	P值^b	r值^a	P值^a	r值^b	P值^b	r值^a	P值^a	r值^b	P值^b
SE	-0.136	0.080	-0.129	0.116	-0.022	0.774	0.083	0.312	0.056	0.470	0.112	0.173
NREM3+4%	-0.105	0.177	-0.100	0.220	-0.003	0.973	-0.054	0.509	0.127	0.102	0.121	0.140
REM%	-0.010	0.897	0.010	0.907	-0.040	0.605	-0.025	0.757	-0.104	0.184	-0.189	0.020
MDOAE	-0.035	0.656	-0.070	0.392	0.004	0.955	-0.096	0.241	-0.039	0.622	0.091	0.265
LDOAE	0.036	0.644	0.030	0.711	0.081	0.297	0.087	0.287	-0.095	0.226	-0.061	0.456
MDHE	-0.021	0.791	-0.119	0.146	0.002	0.978	0.106	0.194	-0.150	0.053	-0.156	0.056
LDHE	0.091	0.246	0.148	0.070	-0.058	0.455	-0.189	0.020	-0.089	0.256	0.102	0.211
AHI	-0.023	0.770	-0.030	0.716	0.062	0.077	0.350	0.426	-0.091	0.244	0.071	0.386
REM-AHI	0.248	0.001	0.192	0.018	0.133	0.088	0.038	0.643	-0.260	0.001	-0.201	0.013
ArI	-0.028	0.718	-0.065	0.426	0.031	0.694	0.050	0.543	-0.078	0.318	-0.087	0.289
LSO₂	-0.161	0.038	-0.082	0.315	-0.162	0.037	-0.070	0.393	0.150	0.053	0.041	0.617
MSO₂	0.006	0.940	0.140	0.086	-0.101	0.195	0.020	0.807	-0.055	0.478	-0.088	0.285
ODI	-0.032	0.682	-0.069	0.400	0.015	0.847	-0.081	0.323	-0.122	0.116	-0.133	0.103
T90	0.129	0.097	-0.025	0.761	0.286	< 0.001	0.067	0.415	-0.080	0.303	0.088	0.284
REM-T90	0.134	0.084	0.030	0.718	0.286	< 0.001	-0.049	0.547	-0.088	0.261	-0.092	0.264
注：^a为Pearson相关，^b为偏相关。

下载: 导出CSV

表 2 REM-AHI分组中各组患者基础资料比较

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	SE (x±s，%)	NREM3+4% [M(P₂₅, P₇₅)，%]	REM% (x±s，%)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	SE (x±s，%)	NREM3+4% [M(P₂₅, P₇₅)，%]	REM% (x±s，%)
无REM-OSAHS组	39	34	5	39.51±14.76	25.77±3.35	84.01±9.98	11.80(9.80, 22.30)	16.25±5.90
轻度REM-OSAHS组	42	29	13	42.83±13.34	25.77±3.35	79.40±11.58	11.55(5.40, 17.43)	18.53±7.70
中度REM-OSAHS组	51	32	19	42.94±12.84	25.37±3.32	81.03±14.50	10.10(6.30, 18.30)	17.23±5.96
重度REM-OSAHS组	34	24	10	40.44±12.40	25.59±3.31	79.01±12.50	16.85(7.18，28.33)	14.54±5.68
统计量		6.785^a		2.297^b	0.119^b	4.574^b	6.841^c	2.624^b
P值		0.079		0.513	0.949	0.206	0.077	0.052
注：^a为χ²值，^b为F值，^c为H值。

下载: 导出CSV

表 3 REM-AHI分组中各组患者3个量表评分比较

组别	例数	ESS评分 (x±s，分)	PSQI评分 [M(P₂₅, P₇₅)，分]	MoCA评分 (x±s，分)
无REM-OSAHS组	39	7.69±4.31	2.00(1.00, 4.00)	25.54±3.61
轻度REM-OSAHS组	42	10.55±3.66^a	2.50(1.00, 4.00)	24.45±3.12
中度REM-OSAHS组	51	11.41±3.32^a	4.00(2.00, 6.00)^ac	23.29±2.85^ac
重度REM-OSAHS组	34	11.62±6.42^a	3.50(2.00, 7.00)^ac	23.00±2.13^ac
统计量		19.082^b	11.094^d	21.164^b
P值		< 0.001	0.011	< 0.001
注：与无REM-OSAHS组比较，^aP < 0.05;与轻度REM-OSAHS组比较，^cP < 0.05。^b为F值, ^d为H值。

下载: 导出CSV

表 4 LSO₂分组中各组患者基础资料比较

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	SE(x±s，%)	NREM3+4% [M(P₂₅, P₇₅)，%]	REM% (x±s，%)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	SE(x±s，%)	NREM3+4% [M(P₂₅, P₇₅)，%]	REM% (x±s，%)
无缺氧组	40	28	12	38.93±13.92	25.06±3.31	80.25±14.79	13.35(8.86，18.98)	17.05±7.40
轻度缺氧组	70	54	6	42.41±13.42	25.55±2.89	80.91±12.35	10.85(5.68, 19.20)	16.10±6.50
中度缺氧组	33	21	12	42.12±12.98	26.13±3.88	81.50±10.70	13.40(8.15, 22.50)	17.01±6.18
重度缺氧组	23	16	7	41.57±12.57	25.67±3.24	81.15±11.27	11.00(4.30, 25.80)	18.04±5.08
统计量		2.187^a		2.254^b	0.667^b	0.124^b	3.088^c	0.576^b
P值		0.534		0.521	0.574	0.989	0.378	0.632
注：^a为χ²值，^b为F值，^c为H值。

下载: 导出CSV

表 5 LSO₂分组中各组患者3个量表评分比较

组别	例数	ESS评分 (x±s，分)	PSQI评分 [M(P₂₅, P₇₅)，分]	MoCA评分 (x±s，分)
无缺氧组	40	10.25±4.21	3.00(1.00, 5.00)	24.30±3.55
轻度缺氧组	70	9.57±4.82	3.00(1.00, 5.00)	24.49±3.19
中度缺氧组	33	10.73±4.41	2.00(1.00, 4.50)	23.64±2.68
重度缺氧组	23	12.43±4.72	5.00(2.00, 9.00)	22.91±2.45
统计量		7.709^a	7.015^b	7.224^a
P值		0.052	0.071	0.065
注：^a为F值，^b为H值。

下载: 导出CSV

参考文献(21)

[1]	周作玲, 陈希胜. 阻塞性睡眠呼吸暂停低通气综合征相关肝损害的危险因素研究[J]. 中华全科医学, 2020, 18(11): 1860-1863. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202011020.htm
[2]	JONAS D E, AMICK H R, FELTNER C, et al. Screening for obstructive sleep apnea in adults: Evidence report and systematic review for the US preventive services task force[J]. JAMA, 2017, 317(4): 415-433. doi: 10.1001/jama.2016.19635
[3]	中华医学会呼吸病学分会睡眠呼吸障碍学组. 家庭无创正压通气临床应用技术专家共识[J]. 中华结核和呼吸杂志, 2017, 40(7): 481-493. doi: 10.3760/cma.j.issn.1001-0939.2017.07.001
[4]	中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi: 10.3760/cma.j.issn.0376-2491.2018.24.003
[5]	KAPUR V K, AUCKLEY D H, CHOWDHURI S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American academy of sleep med clinical practice guideline[J]. J Clin Sleep Med, 2017, 13(3): 479-504. doi: 10.5664/jcsm.6506
[6]	应丽娟, 梁敏烈. 阻塞性睡眠呼吸暂停低通气综合征对高血压患者心脏自主神经功能的影响[J]. 中国临床研究, 2018, 31(12): 1648-1651. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201812014.htm
[7]	汪迎春, 张瑜, 曹梅, 等. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者皮质下觉醒反应与糖代谢相关性研究[J]. 中华全科医学, 2018, 16(8): 1261-1263, 1333. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201808012.htm
[8]	HILL E A, FAIRLEY D M, MCCONNELL E, et al. Utility of the pictorial Epworth sleepiness scale in the adult down syndrome population[J]. Sleep Med, 2020, 66: 165-167. doi: 10.1016/j.sleep.2019.10.003
[9]	SEIDI P A M, MOHAMMADI H, KHAZAIE H, et al. Psychometric properties of the Kurdish version of Pittsburgh sleep quality index[J]. Sleep Med, 2019, 63: 75-81. doi: 10.1016/j.sleep.2019.04.022
[10]	HAYEK M, TARABEY L, ABOU-MRAD T, et al. Normative data for the Montreal cognitive assessment in a Lebanese older adult population[J]. J Clin Neurosci, 2020, 74: 81-86. doi: 10.1016/j.jocn.2020.01.050
[11]	SINGLA V, GATTU T, AGGARWAL S, et al. Evaluation of Epworth sleepiness scale to predict obstructive sleep apnea in morbidly obese patients and increasing its utility[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(3): 298-302. doi: 10.1089/lap.2018.0329
[12]	KANG J M, KANG S G, CHO S J, et al. The quality of life suspected obstructive sleep apnea patients is related to their subjective sleep quality rather than the apnea-hypopnea index[J]. Sleep Breath, 2017, 21(2): 369-375. doi: 10.1007/s11325-016-1427-8
[13]	HE Y Y, XIANG L, ZHAO L P, et al. Relationship between soluble Semaphorin4D and cognitive impairment in patients with obstructive sleep apnea-hypopnea syndrome[J]. Eur Arch Otorhinolaryngol, 2017, 274(3): 1263-1268. doi: 10.1007/s00405-016-4224-x
[14]	YALCINER G, BABADEMEZ M A, GUL F. Association of sleep time in supine position with apnea-hypopnea index as evidenced by successive polysomnography[J]. Sleep Breath, 2017, 21(2): 289-294. doi: 10.1007/s11325-016-1401-5
[15]	蒋康伦, 赵琳, 李姝娜, 等. 快速动眼睡眠相关性阻塞性睡眠呼吸暂停事件的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(10): 744-748. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201710003.htm
[16]	LEE S A, PAEK J H, HAN S H. REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women[J]. Sleep Breath, 2016, 20(3): 995-1002. doi: 10.1007/s11325-016-1323-2
[17]	赵翠, 陈军, 巴春贺, 等. 阻塞性睡眠呼吸暂停低通气综合征成年患者睡眠监测特点及临床表现的分析[J]. 河北医学, 2020, 26(3): 458-462. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202003026.htm
[18]	ALZOUBAIDI M, MOKHLESI B. Obstructive sleep apnea during rapid eye movement sleep: Clinical relevance and therapeutic implications[J]. Curr Opin Pulm Med, 2016, 22(6): 545-554.
[19]	SUNNETCIOGLU A, SERTOGULLARINDAN B, OZBAY B, et al. Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: Comparison of demographic, anthropometric, and polysomnographic features[J]. J Bras Pneumol, 2016, 42(1): 48-54.
[20]	ERNST G, BOSIO M, SALVADO A, et al. Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): Proportional increase associated with degree of obesity[J]. Sleep Breath, 2016, 20(4): 1175-1183.
[21]	KOO D L, NAM H. Clinical considerations of obstructive sleep apnea with little REM sleep[J]. J Clin Neurol, 2016, 12(4): 426-433.