不同严重程度的阻塞性睡眠呼吸暂停低通气综合征患者呼吸道阻力的变化及临床意义

目的研究不同严重程度的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸道阻力的变化及临床意义。方法选取96例2015年3月~2017年5月我院收治的OSAHS患者为研究对象,根据OSAHS病情严重程度分为轻度组37例(轻度:AHI:5~15次/h)和中、重度组59例(中度及重度:AHI>15次/h),观察比较两组个人体格特征指数(体重指数、颈围、腹围及呼吸暂停低通气指数(AHI))、气道阻抗指标总呼吸阻抗(Z5)、总气道阻力(R5)、中心气道阻力(R20)、外周(肺及周围小器官)弹性阻力(X5)、50%用力呼气流速(FEF50%)、中段用力呼气流速(MMEF)]及睡眠参数最低血氧饱和度(LSaO 2)、微觉醒指数(ArI)、呼吸暂停指数(Apnea index,AI)、低通气指数(HI)],并作呼吸阻抗指标与AHI的相关性分析及嗜睡量表(ESS)和ArI与睡眠参数及AHI的相关性分析。结果中、重度组患者体重指数、颈围、腹围及AHI明显高于轻度组,差异具有统计学意义(P<0.05);观察组Z5、R5、R20、FEF50%及MMEF值明显高于轻度组(P<0.05);两组X5值比较差异无统计学意义(P>0.05);轻度组ArI、AI、HI值明显低于中、重度组(P<0.05);轻度组LSaO 2值明显高于中、重度组(P<0.05);AHI与Z5、R5、R20、FEF50%呈正相关,与X5、MMEF无相关性(P>0.05);ESS与ArI、AI、AHI呈正相关,与LSaO 2呈负相关(P<0.05);ArI与AI、AHI呈正相关,与LSaO 2呈负相关(P<0.05);ESS与HI及ArI与HI无相关性(P>0.05)。结论不同严重程度OSAHS患者个人体格特征指数、气道阻抗指标及睡眠参数存在较大差异,OSAHS患者病程进展与气道阻抗指标相关,且ESS与ArI和相关睡眠指数具有相关性。

Changes and its clinical significance of airway resistance in patients with obstructive sleep apnea-hypopnea syndrome of different severity degrees

Objective To investigate the changes and its clinical significance of airway resistance in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)of different severity.Methods From March 2015 to May 2017,96 OSAHS patients in our hospital were selected,and they were divided into two groups according to the severity degrees,the mild group(n=37,AHI:5~15 times/h)and the moderate-severe group(n=59,AHI>15 times/h).Then various indexes were compared between the two groups,including physical characteristics indexes(body mass index,neck circumference,abdominal circumference and apnea hyponea index(AHI)),airway resistance indexesimpedance at 5 Hz(Z5),airway resistance at 5 Hz(R5),central airway resistance at 20 Hz(R20),reactance at 5 Hz(X5),forced expiratory flow at 50%(FEF50%),maximal mid-expiratory flow(MMEF)],sleep parameterslowest oxygen saturation(LSaO 2),microarousal index(ArI),apnea index(AI),hypopnea index(HI)]and the Epworth sleepiness scale(ESS).Results Their body mass index,neck circumference,abdominal circumference and AHI of the moderate-severe group were significantly higher than those of the mild group(P<0.05).The Z5,R5,R20,FEF50%and MMEF in the moderate-severe group were significantly higher than those in the mild group(P<0.05).There was no significant difference in the X5 between the two groups(P>0.05).The value of ArI,HI and AI in the mild group was significantly lower than that in the moderate-severe group(P<0.05).The level of LSaO 2 in the mild group were significantly higher than that in the moderate-severe group(P<0.05).AHI was positively correlated with Z5,R5,R20 and FEF 50%,and had no correlation with X5 and MMEF(P>0.05).ESS was positively correlated with ArI,AI and AHI,and negatively correlated with LSaO 2(P<0.05).ArI was positively correlated with AI and AHI,and negatively correlated with LSaO 2(P<0.05).There was no correlation between ESS and HI as well as between ArI and HI(P>0.05).Conclusion The individual physical characteristics index,airway impedance index and sleep parameters of OSAHS patients with different severity are significantly different.The progression of OSAHS is correlated with airway impedance index,and ESS is correlated with ArI and related sleep indexes.