成人阻塞性睡眠呼吸暂停低通气综合征患者白天过度嗜睡临床特征及影响因素分析

doi:10.6040/j.issn.1673-3770.0.2020.422

摘要/Abstract

摘要： 目的探讨成人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者白天过度嗜睡(EDS)的临床特征及影响因素。方法回顾性分析经多导睡眠呼吸监测(PSG)确诊为OSAHS的565例成人患者资料。根据Epworth 嗜睡量表(ESS)评分分为非EDS组(ESS≤10分)和EDS组(ESS>10分),其中非EDS组400例,EDS组165例。收集所有患者的一般资料(如性别、年龄、BMI、颈胸腰腹臀围、腰臀比等)、PSG参数(包括AHI等睡眠呼吸事件指标、LSaO₂、TS90%等夜间血氧指标、各睡眠期比例等睡眠结构指标)以及主观ESS评分。统计EDS的发病率以及嗜睡程度的分布,比较非EDS组与EDS组的临床特征差异,探讨EDS的影响因素。结果 (1)成人OSAHS患者EDS发病率是29.2%,男性高于女性,随年龄增加而下降(P=0.001),随BMI(P<0.001)、OSAHS严重程度(P=0.001)以及低血氧症程度(P<0.001)的加重而升高(P<0.05);(2)EDS组患者的身高(P=0.016)、体质量(P<0.001)、BMI(P<0.001)、颈围(P<0.001)、胸围(P=0.002)、腰围(P<0.001)、腹围(P=0.000)、臀围(P=0.002)均大于非EDS组患者,差异具有统计学意义(P<0.05)。EDS组患者的睡眠呼吸监测指标均较非EDS组严重,二者在总睡眠时间(P<0.001)、睡眠效率(P=0.003)、AHI(P<0.001)、REM AHI(P=0.001)、NREM AHI(P<0.001)、LSaO₂(P<0.001)、ASaO₂(P<0.001)、TS90%(P<0.001)、氧减指数(P<0.001)、微觉醒指数(P<0.001)、最长呼吸暂停时间(P<0.001)、浅睡眠期比例(P<0.001)、N3期比例(P<0.001)以及晨起舒张压(P=0.010)差异均具有统计学意义(P<0.05);(3)不同嗜睡程度EDS患者的平均年龄相似,其体质量(P=0.002)、BMI(P<0.001)、颈围(P=0.010)、胸围(P=0.028)、腰围(P=0.006)、腹围(P=0.003)差异有统计学意义(P<0.05)。嗜睡程度越重,其睡眠时间越长(P=0.047),睡眠效率越高(P=0.019)、AHI(P<0.001)、REM AHI(P<0.001)、NREM AHI(P<0.001)、TS90%(P<0.001)、氧减指数(P<0.001)、微觉醒指数(P=0.004)、最长呼吸暂停时间(P=0.030)、晨起收缩压(P=0.047)和舒张压(P=0.024)指标值越高,LSaO₂(P<0.001)、ASaO₂(P<0.001)则是逐渐降低,差异均具有统计学意义(P<0.05);(4)主观ESS评分与AHI(r=0.263,P<0.001)、NREM AHI(r=0.267,P<0.001)、TS90%(r=0.240,P<0.001)、氧减指数(r=0.275,P<0.001)、微觉醒指数(r=0.253,P<0.001)以及最长呼吸暂停时间(r=0.219,P<0.001)呈弱正相关,与LSaO₂(r=-0.266,P<0.001)、ASaO₂(r=-0.236,P<0.001)呈弱负相关,相关性具有统计学意义(P<0.05);(5)二元Logistic回归分析发现,TS90%(P=0.001)及氧减指数(P=0.029)是EDS发病的危险因素(P<0.05)。氧减指数(P<0.001)是白天嗜睡程度的危险因素(P<0.05)。结论成人OSAHS患者EDS发病率男性高于女性,随年龄增加而下降,随BMI、OSAHS严重程度以及低血氧症程度的加重而升高。与非EDS患者相比,EDS组患者存在更严重的超重肥胖特征,睡眠时间更长,睡眠效率更高,睡眠结构更紊乱、睡眠呼吸相关参数和夜间低氧参数异常更严重。TS90%及氧减指数对成人OSAHS患者EDS发病有显著影响,其中氧减指数可能决定患者白天嗜睡程度。

关键词: 睡眠呼吸暂停,阻塞性, 低通气, 白天过度嗜睡, Epworth嗜睡量表, 影响因素

Abstract: Objective Clinical and polysomnography(PSG)data of obstructive sleep apnea(OSA)patients with and without excessive daytime sleepiness(EDS)were analyzed to investigate correlation factors for the Epworth Sleepiness Scale(ESS)and to explore the effect of surgical intervention for OSA on patients' level of EDS. Methods In total, 565 adult patients diagnosed with OSAHS using PSG in the otorhinolaryngology clinic of our hospital between June 2018 and June 2019 were analyzed retrospectively. The patients were divided into the non-EDS group(ESS≤10 points)and the EDS group(ESS>10 points)according to their ESS scores, of which 400 were assigned to the non-EDS group and 165 to the EDS group. General clinical data of all patients(such as sex, age, body mass index(BMI), neck and chest circumference, waist-to-hip ratio, etc.), PSG parameters(including indexes of sleep respiratory events such as the apnea-hypopnea index(AHI), nocturnal blood oxygen parameters such as LSaO₂ and TS90%, indexes of sleep structure such as the proportion of each sleep period, etc.), and subjective ESS scores were observed; the incidence of EDS and the distribution of the EDS degree were investigated statistically, and the differences in clinical characteristics between the non-EDS and EDS groups were compared. The influencing factors for EDS were explored. Results (1) EDS incidence in adult patients with OSAHS was 29.2%. There were significant differences in sex, age(P=0.001), BMI(P<0.001), level of AHI(P=0.001), and hypoxemia(P<0.001)(P<0.05)between the groups, all of which influenced the incidence of EDS. (2) The distribution of age was similar between the EDS and non-EDS groups(P>0.05). Patients' height(P=0.016), weight(P<0.001), BMI(P<0.001), neck circumference(P<0.001), chest circumference(P=0.002), waist circumference(P<0.001), abdominal circumference(P<0.001), and hip circumference(P=0.002)measurements in the EDS group were all higher than those of patients in the non-EDS group, and all the differences were statistically significant(P<0.05). There were statistically significant differences in total sleep time(P<0.001), sleep efficiency (P=0.003), overall AHI(P<0.001), REM AHI(P=0.001), non-REM AHI(P<0.001), LSaO₂(P<0.001), ASaO₂(P<0.001), TS90%(P<0.001), oxygen reduction index(P<0.001), microarousal index(P<0.001), maximum apnea time(P<0.001), and other sleep respiratory parameters between the EDS and non-EDS groups(P<0.05). (3) The mean age of daytime sleepiness patients with different degrees of sleepiness was similar, and there were statistical differences in body weight(P=0.002), BMI(P<0.001), neck circumference(P=0.010), chest circumference(P=0.028), waist circumference(P=0.006)and abdominal circumference(P=0.003)(P<0.05). The higher the degree of sleepiness, the longer the sleep duration(P=0.047), The higher sleep efficiency(P=0.019), AHI(P<0.001), REM AHI(P<0.001), and NREM The higher the indexes of AHI(P<0.001), TS90%(P<0.001), oxygen deactivation index(P<0.001), microarousal index(P=0.004), maximum apnea time(P=0.030), morning systolic blood pressure(P=0.047)and diastolic blood pressure(P=0.024),LSaO2(P<0.001)and AsaO2(P<0.001)were gradually decreased, and the differences were statistically significant(P<0.05).(4) The subjective ESS score was significantly correlated with AHI(r=0.263, P<0.001), non-REM AHI(r=0.267, P<0.001), LSaO₂(r=-0.266, P<0.001), ASaO₂(r=-0.236, P<0.001), TS90%(r=0.240, P<0.001), oxygen reduction index(r=0.275, P<0.001), microarousal index(r=0.253, P<0.001), and maximum apnea duration(r=0.219, P<0.001)(P<0.05). (5) Binary logistic regression analysis showed that TS90%(P=0.001)and oxygen decrease(P=0.029)index were risk factors for EDS(P<0.05). The oxygen decrease index(P<0.001)may determine the degree of daytime sleepiness. Conclusion The incidence of EDS can be affected by sex, age, BMI, AHI, and severity of hypoxemia. The severity of EDS can be influenced by BMI, severity of OSAHS, and hypoxemia level. Compared with the non-EDS group, the EDS group had a longer sleep time, higher sleep efficiency, and a higher index of PSG parameters. TS90% and oxygen decrease index were risk factors for EDS. The oxygen decrease index may determine the degree of daytime sleepiness.

Key words: Sleep apnea, obstructive, Hypopnea, Excessive daytime sleepiness, Epworth sleepiness scale, Affect factor

中图分类号:

R766.7

陈金辉,黄婷,董洁,徐勇,韩继波,罗志宏,陶泽璋. 成人阻塞性睡眠呼吸暂停低通气综合征患者白天过度嗜睡临床特征及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 22-29.

CHEN Jinhui, HUANG Ting, DONG Jie, XU Yong, HAN Jibo, LUO Zhihong, TAO Zezhang. Analysis of the characteristics of excessive daytime sleepiness in adult patients with obstructive sleep apnea-hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 22-29.

参考文献

[1] Sahni AS, Carlucci M, Malik M, et al. Management of excessive sleepiness in patients with narcolepsy and OSA: current challenges and future prospects[J]. Nat Sci Sleep, 2019, 11: 241-252. doi:10.2147/NSS.S218402.
[2] Garbarino S. Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses[J]. Schlaf Atmung, 2020, 24(1): 37-47. doi:10.1007/s11325-019-01903-6.
[3] 黄婷, 陈金辉, 韩继波, 等. 成人阻塞性睡眠呼吸暂停低通气综合征患者白天过度嗜睡特征及手术干预效果分析[J]. 中国耳鼻咽喉头颈外科, 2020,27(5): 275-278. doi:10.16066/j.1672-7002.2020.05.011. HUANG Ting, CHEN Jinhui, HAN Jibo, et al. Analysis on the characteristics of excessive daytime sleepiness and the effect of surgical intervention in adult patients with obstructive sleep apnea hyponea syndrome[J]. Chin Arch Otolaryngol-Head Neck Surg, 2020,27(5): 275-278. doi:10.16066/j.1672-7002.2020.05.011.
[4] Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale[J]. Sleep, 1991, 14(6): 540-545. doi:10.1093/sleep/14.6.540.
[5] Johns M, Hocking B. Daytime sleepiness and sleep habits of Australian workers[J]. Sleep, 1997, 20(10): 844-849. doi:10.1093/sleep/20.10.844.
[6] American Academy of Sleep Medicine. International Classification of Sleep Disorders[M]. 3rd Edn. Darien, IL:2014.
[7] Gandhi KD, Mansukhani MP, Silber MH, et al. Excessive Daytime Sleepiness: A Clinical Review[J]. Mayo Clin Proc, 2021,96(5):1288-1301.doi: 10.1016/j.mayocp.2020.08.033.
[8] Inoue Y, Takasaki Y, Yamashiro YJ. Efficacy and safety of adjunctive modafinil treatment on residual excessivedaytime sleepiness among nasal continuous positive airway pressure-treated japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study[J]. Clin Sleep Med, 2013,(8):751-757. doi: 10.5664/jcsm.2912.
[9] Léger D, Stepnowsky C. The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea[J]. Sleep Medicine Reviews, 2020,51:101275. doi: 10.1016/j.smrv.2020.101275.
[10] 朱先极, 张希龙. 阻塞性睡眠呼吸暂停低通气综合征与白天嗜睡[J]. 中国中西医结合耳鼻咽喉科杂志, 2015,23(2): 138-141. doi:10.16542/j.cnki.issn.1007-4856.2015.02.017.
[11] 陈宇洁, 赵杰, 陆海英, 等. 睡眠呼吸暂停低通气综合征患者白天嗜睡的研究[J]. 国际内科学杂志, 2007, 34(9): 504-506. CHEN Yujie, ZHAO Jie, LU Haiying, et al. The research of somnolence in sleep apnea hypopnea syndrome patients[J]. Int J Intern Med, 2007, 34(9): 504-506.
[12] Morrell M, Finn L, McMillian A, et al. The impact of ageing and sex on the association between sleepiness and sleep disordered breathing[J]. Eur Respir J,2012,40(2):386-393. doi: 10.1183/09031936.00177411.
[13] Vicini C, de Vito A, Iannella G, et al. The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome[J]. Eur Arch Otorhinolaryngol, 2018, 275(12): 2983-2990. doi:10.1007/s00405-018-5163-5.
[14] Iannella G, Vicini C, Colizza A, et al. Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study[J]. Eur Arch Otorhinolaryngol, 2019, 276(12):3549-3556. doi: 10.1007/s00405-019-05616-0.
[15] Huamaní C, Rey de Castro J, Mezones-Holguín E. Sleepiness and nocturnal hypoxemia in Peruvian men with obstructive sleep apnea[J]. Schlaf Atmung, 2014, 18(3): 467-473. doi:10.1007/s11325-013-0907-3.
[16] Ryu HS, Lee SA, Lee GH, et al. Subjective apnoea symptoms are associated with daytime sleepiness in patients with moderate and severe obstructive sleep apnoea: a retrospective study[J]. Clin Otolaryngol, 2016, 41(4): 395-401. doi:10.1111/coa.12659.
[17] Mendes FA, Marone SA, Duarte BB, et al. Epidemiologic profile of patients with snoring and obstructive sleep apnea in a university hospital[J]. Int Arch Otorhinolaryngol, 2014, 18(2): 142-145. doi:10.1055/s-0033-1359309.
[18] 刘海琴, 冯雅妮, 张一彤, 等. 成人不同程度睡眠呼吸紊乱白天过度嗜睡影响因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020,34(3): 266-269. doi:10.13201/j.issn.2096-7993.2020.03.020. LIU Haiqin, FENG Yani, ZHANG Yitong, et al. Analysis of influencing factors of excessive daytime sleepiness in adults with different degrees of sleep-disordered breathing[J]. J Clin Otorhinolaryngol Head Neck Surg, 2020, 34(3): 266-269. doi:10.13201/j.issn.2096-7993.2020.03.020.
[19] Chen R, Xiong KP, Lian YX, et al. Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients[J]. Schlaf Atmung, 2011, 15(1): 129-135. doi:10.1007/s11325-010-0337-4.
[20] Sun YF, Ning YP, Huang LL, et al. Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome[J]. Schlaf Atmung, 2012, 16(2): 375-381. doi:10.1007/s11325-011-0515-z.
[21] Roure N, Gomez S, Mediano O, et al. Daytime sleepiness and polysomnography in obstructive sleep apnea patients[J]. Sleep Med, 2008, 9(7):727-731. doi: 10.1016/j.sleep.2008.02.006.
[22] Jiménez-Correa U, Haro R, González-Robles RO, et al. How is the Epworth Sleepiness Scale related with subjective sleep quality and polysomnographic features in patients with sleep-disordered breathing?[J]. Schlaf Atmung, 2011, 15(3): 513-518. doi:10.1007/s11325-010-0372-1.
[23] Bausmer U, Gouveris H, Selivanova O, et al. Correlation of the Epworth Sleepiness Scale with respiratory sleep parameters in patients with sleep-related breathing disorders and upper airway pathology[J]. Eur Arch Otorhinolaryngol, 2010, 267(10): 1645-1648. doi:10.1007/s00405-010-1250-y.
[24] Mediano O, Barceló A, de la Peña M, et al. Daytime sleepiness and polysomnographic variables in sleep apnoea patients[J]. Eur Respir J, 2007, 30(1):110-113. doi: 10.1183/09031936.00009506.
[25] Cho YW, Lee JH, Son HK, et al. The reliability and validity of the Korean version of the Epworth sleepiness scale[J]. Sleep Breath, 2011, 15(3):377-384. doi: 10.1007/s11325-010-0343-6.

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