男性与女性睡眠呼吸暂停低通气综合征患者临界压的对比研究

目的用临界压(Pcrit)来提示男性与女性睡眠呼暂停低通气综合症(SAHS)患者发病方式上的差别,进而用于指导临床治疗.方法分别对202名男性、66名女性进行多导睡眠图(PSG)检查;用压力振荡技术(Forced oscillation technique,FOT)在患者平卧位快动眼睡眠Ⅱ期对通气量与压力的关系,用外推法在气流为零时作图解出Pcrit.并对SAHS3组中的男性及女性患者试用持续正压通气(CPAP)治疗.结果pcrit在女性SAHS1组为(0.8±0.7)cmH2O,SAHS2组为(1.4±0.6)cmH2O,SAHS3组为(1.4±1.2)cmH2O,三组间无显著意义;而Pcrit在男性SAHS1组为(1.2±0.6)cmH2O,SAHS2组为(1.7±0.8)cmH2O,SAH3组为(2.4±0.8)cmH2O,三组间比较均有非常显著增高的意义.男性SAH3组患者的Pcrit亦显著地高于女性SAH3组患者;并且Pcrit与男性SAH3组患者的OAI、MAI呈非常显著正相关;而男性患者的OAI、MAI又与BMI均呈非常显著正相关.女性患者pcrit与OAI、MAI及OHI均无相关关系,但女性患者OHI与BMI显著正相关.SAH3组男性及女性患者接受CPAP治疗的顺应性分别为40.6%及10.5%.结论pcrit能从功能上反映男性SAHS患者睡眠时咽部塌陷的程度;女性患者以OH为主,Pcrit较小,咽部塌陷较轻;这对临床治疗有一定的指导意义.

Comparison of differences in pharyngeal critical pressure between male and female patients with sleep apnea/hypopnea syndrome

Objective: To elucidate the differences in pharyngeal critical pressure(Pcrit) between male and female patients with sleep apnes/hypopnea syndrome (SAHS). Methods: 202 males and 66 females were checked up by PSG individually, in which 33 males served as normal male control group (N) and 12 females as normal female control group (N). The other 169 male and 54 female patients with SAHS were divided into SAHS1, SAHS2, and SAHS3 groups according to AASM Task Force (1999). Among them, 93 male and 23 female patients with SAHS were checked up by maximal inspiratory flow and pressure using the forced oscillation technique (FOT), then Pcrit was derived from the relationship between the flow and the pressure, which represented the extrapolated pressure at zero flow by graph individually. The male SAHS3 and female SAHS3 patients were treated with continuous positive airway pressure (CPAP) individually at night (sleep time) forprobation. Results: Pcrits in female SAHS1, SAHs2 and SAHS3 groups were (0.8±0.7)cmH2O, (1.4±0.6)cmH2O and(1.4±1.2) cmH2O, respectively. The Pcrits were not significantly different among these groups. Pcrits in male SAHS1, SAHS2, SAHS3 groups were (1.2±0.6)cmH2O, (1.7±0.8)cm H2O and (2.4±0.8) cmH20, respectively.The Pcrit in male SAHS3 group was significantly higher than that in male SAHS2 group, and the Pcrit in latter was significantly higher than that in male SAHS1 group. Pcrit in male SAHS3 group was significantly higher than that in the corresponding female group, while Pcrit was significantly positively correlated with obstructive apnea index (OAI) and mixed apnea index (MAI), and the two latter ones were significantly positively correlated with body mass index (BMI) in male SAHA patients. Pcrit was not related with OAI, MAI and obstructive hypopnea index (OHI) profoundly, but BMI was significantly positively correlated with OHI in female SAHS patients. Compliances treated with continuous positive airway pressure (CPAP) were 40.6% in male SAHS3 and 10.5 % in female SAHS3 patients individually. Conclusions: Pcrit can precisely assess the severity of the upper airway collapsibility in sleep in male SAHS patient. Obstructive hypopnea is found much more in all three female SAHS groups, in whom the Pcrit is not higher, and pharyngeal collapsibility is not severer. The conclusions can be beneficial to choosing clinical therapies.