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首页> 中文期刊> 《中国全科医学》 >肥胖程度及睡眠体位对阻塞性睡眠呼吸暂停低通气综合征患者的影响研究

肥胖程度及睡眠体位对阻塞性睡眠呼吸暂停低通气综合征患者的影响研究

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摘要

Background Obesity is a recognized risk factor for the development of obstructive sleep apnea hypopnea syndrome (OSAHS).Changing sleep position as a treatment for OSAHS has been widely recommended.However,few researches exist in China for the effect of changing sleep position on OSAHS patients with different degrees of obesity.Objective To investigate the effect of sleep position and obesity degrees on OSAHS,and the relationship between positional OSAHS and anthropometric parameters of obesity.Methods We conducted a retrospective study on 678 patients with OSAHS determined by overnight polysomnography (PSG) in West China Hospital,Sichuan University,from January 2015 to June 2016.We obtained and analyzed the baseline and PSG characteristics of the patients,and calculated the postural dependence index.The patients were divided into 3 groups:normal weight group (n =139),overweight group (n =315) and obese group (n =224) according to body mass index (BMI).We compared the anthropometric parameters and PSG characteristics between the positional OSAHS group (n =288) and the non-positional OSAHS group (n =390) divided by the postural dependence index.Influencing factors for positional OSAHS were investigated.Results There were significant differences in score of Epworth Sleepiness Scale (ESS),arousal index,respiratory effort related arousals (RERA) index,apnea-hypopnea index (AHI),SaO2 ＜ 90％ time / total sleep time (TST),mean SaO2 (MSaO2),lowest SaO2 (LSaO2),non-supine AHI,supine AHI and positional dependency index among normal weight group,overweight group and obese group (P ＜ 0.05).The male ratio,BMI,waist circunfference,hip circumference,waist-to-hip ratio,score of ESS,arousal index,RERA index,AHI and SaO2 ＜ 90％ time / TST of positional OSAHS group were significantly lower than those of non-positional OSAHS group (P ＜ 0.05).Furthermore,positional OSAHS group had higher MSaO2 and LSaO2 (P ＜ 0.05).Results of Spearman correlation analysis showed that positional dependency was negatively correlated with BMI,waist circumference,hip circunfference and waist to hip ratio (rs =-0.295,-0.289,-0.219,-0.236,P ＜0.001,respectively).Multivariate Logistic regression analysis found that positional OSAHS had a regression relationship with gender [OR =0.620,95％ CI (0.392,0.979),P =0.040] and BMI [OR=0.879,95％CI (0.802,0.943),P=0.001].Conclusion The severity of OSAHS is significantly correlated with the degree of obesity,while BMI shows an inverse relationship with positional dependency.Gender and BMI are independent factors for postural OSAHS.The higher the BMI,the less effects that changing sleep position would have on respiratory events.Thus,positional therapy alone may not improve the conditions of such patients.More active treatments should be considered as soon as possible.%背景 肥胖是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发病公认的危险因素之一,改变睡眠体位作为OSAHS的一种治疗手段已被广泛推荐,不同肥胖程度患者改变睡眠体位是否均能影响OSAHS严重程度,国内尚未见相关研究报道.目的 探讨肥胖程度及睡眠体位对OSAHS的影响,以及体位性OSAHS与肥胖相关指标的相关性.方法 回顾性分析2015年1月-2016年6月四川大学华西医院睡眠呼吸监测室行多导睡眠图(PSG)监测并诊断为OSAHS的患者678例.收集患者一般资料及PSG监测指标,根据体质指数(BMI)将患者分为体质量正常组(n=139)、超重组(n =315)、肥胖组(n=224),分析其PSG监测指标及体位依赖性指数;根据体位依赖性指数将患者分为体位性OSAHS组(n =288)及非体位性OSAHS组(n=390),分析其肥胖相关人体测量指标和PSG监测指标,以及体位性OSAHS的影响因素.结果 体质量正常组、超重组、肥胖组患者Epworth嗜睡量表(ESS)评分、微觉醒指数、呼吸努力相关微觉醒(RERA)指数、呼吸暂停低通气指数(AHI)、血氧饱和度(SaO2)＜90％时间占总睡眠时间(TST)比例、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)、非仰卧位AHI、仰卧位AHI、体位依赖性指数比较,差异均有统计学意义(P＜0.05).体位性OSAHS组患者男性比例、BMI、腰围、臀围、腰臀比、ESS评分、微觉醒指数、RERA指数、AHI、SaO2＜ 90％时间占TST比例低于非体位性OSAHS组,MSaO2、LSaO2高于非体位性OSAHS组(P＜0.05).Spearman相关分析结果显示,体位依赖性指数与BMI、腰围、臀围、腰臀比均呈负相关(-=-0.295、-0.289、-0.219、-0.236,P＜0.001).多因素Logistic回归分析结果显示,性别[OR=0.620,95％CI(0.392,0.979),P=0.040]和BMI[OR=0.879,95％CI(0.802,0.943),P=O.001]与体位性OSAHS有回归关系.结论 OSAHS的病情严重程度与肥胖程度呈正相关,而BMI与体位依赖性指数呈负相关,性别和BMI是体位性OSAHS的独立影响因素,BMI越高,患者改变睡眠体位对呼吸事件的影响越小,单纯改变睡眠体位可能无法改善该类患者的病情,应尽早考虑联合更为积极的治疗.

著录项

  • 来源
    《中国全科医学》 |2017年第11期|1294-1299|共6页
  • 作者

    张润; 王茂筠; 王怡唯; 胡碧; 雷飞; 梁宗安;

  • 作者单位

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

    611730四川省成都市,成都上锦南府医院呼吸与危重症医学科;

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

    610041四川省成都市,四川大学华西医院睡眠医学中心;

    610041四川省成都市,四川大学华西医院呼吸与危重症医学科;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 呼吸困难;
  • 关键词

    睡眠呼吸暂停,阻塞性; 人体质量指数; 睡眠; 肥胖症;

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