阻塞性睡眠呼吸暂停低通气综合征临床分级标准的研究

目的寻找能更全面反映阻塞性睡眠呼吸暂停低通气综合征（OSAHS）病理损害程度的多导睡眠监测（PSG）指标。方法以合适的呼吸暂停低通气指数（AHI）将重度患者分组,体现其病情严重程度间的差异性。对621例监测者的主观症状评估量表结果与多导睡眠监测指标进行分析。结果患者AHI、呼吸暂停低通气时间指数（AHTI）、最低血氧饱和度与ESS前7项总分（ESS7）、晨起口干、白天精力与困倦感,均存在极显著相关性（P〈0．01）,与返酸、烧心症状存在显著相关性（均P〈0．05）。AHTI、AHI与ESS7相关（r=0．344,0．317）;与晨起口干相关（r=0．261,0．239）;与返酸,烧心症状相关（r=0．137,0．138）。以AHI≥70次／h区分重度与极重度患者晨起口干、返酸、烧心症状及ESS7均存在极显著差异性（均P〈0．01）。结论呼吸暂停及低通气时间指数AHTI与AHI密切相关,并能更加全面的反映OSAHS病理损害的严重程度。重度患者之问病情严重程度存在差异,以AHI≥170次／h区分重度与极重度问差异显著。

Significance of apnea hypopnea time index in obstructive sleep apnea hypopnea syndrome patients and possible correlation between polysomnographic parameters and severity of the disease

OBJECTIVE: To find out the polysomnography (PSG) indexes that reflex the degree of pathology of obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Six hundred and twenty-one male OSAHS patients, aged over 21, underwent measurement of weight, height, and neck circumference. Polysomnography was conducted to detect the apnea and hypopnea index (AHI), apnea and hypopnea time (AHT), and apnea and hypopnea time index (AHTI). A questionnaire survey based on Epworth sleep scaling (ESS) was conducted among 392 patients to assess the symptoms, such as excessive daytime sleepiness. 324 patients with an AHTI of 68.4 +/- 17.16 events/hour were regarded as severe group, and those with an AHTI >or= 7 events/hr were regarded as very severer group. The relationship among clinical characteristics and polysomnographic parameters were analyzed. RESULTS: The AHI, AHTI, and lowest SaO(2) of the patients were significantly correlated with the ESS7 scores, morning mouth dryness, daytime fatigue (all P < 0.01), and significantly correlated with sour regurgitation, and heartburn, (all P < 0.05). AHTI was significantly correlated (r = 0.317), morning mouth dryness (r = 0.239); and sour regurgitation, and heartburn (r = 0.137). AHT was significantly correlated (r = 0.344), morning mouth dryness (r = 0.261); and sour regurgitation, and heartburn (r = 0.138). Very significant differences existed in morning mouth dryness, sour regurgitation and heartburn, and ESS7 scores between the severe and very severe patients (all P < 0.01). CONCLUSION: Among the PSG indexes, AHTI is better associated with sleepiness and other clinical symptoms than AHI. In severe OSAHS patients, there are significant differences in their clinical symptoms between the AHI < 70 events/hr group and AHI >or= 70 events/hr group.