持续气道正压通气治疗OSAHS 合并咳嗽性晕厥的临床观察

摘要:目的 研究持续气道正压通气 （CPAP） 治疗对阻塞性睡眠呼吸暂停低通气综合征 （OSAHS） 合并咳嗽性晕厥患者相关症状的改善程度。方法 收集我院呼吸内科收治的 OSAHS 合并咳嗽性晕厥患者 43 例， 收集其病历资料和睡眠问卷， 分析 OSAHS 各项指标与晕厥次数的相关性， 予患者 CPAP 治疗， 半年后根据 CPAP 依从性不同将患者分为依从性好组 （26 例）， 依从性差组 （17 例）； 比较 2 组治疗前后的睡眠呼吸暂停低通气指数(AHI)及 C-反应蛋白（CRP） 改善情况。结果 OSAHS 患者的 AHI、 体质指数、 CRP、 嗜睡评分、 颈围、 腹围均与咳嗽性晕厥累计发生次数呈正相关 （r 分别为 0.612、 0.431、 0.224、 0.654、 0.435、 0.344， 均 P < 0.05）。所有患者经过 CPAP 及药物治疗 1～2 周后，均未再发生咳嗽性晕厥。出院半年后随访， CPAP 依从性好的患者未再发生咳嗽性晕厥， CPAP 依从性差的患者中少数患者咳嗽性晕厥仍有发生， 但发生次数减少。治疗前， 2 组 AHI （45.00±15.69 vs. 48.70±16.47）、 CRP （3.46±1.15 vs. 3.38±0.72） 无明显差异。治疗后依从性好组 AHI （26.97±14.06 vs. 48.18±15.96）、 CRP （1.56±0.76 vs. 3.18±0.78） 均低于依从性差组 （均 P < 0.01）。结论 及时持续治疗睡眠呼吸暂停疾病有助于减少患者咳嗽性晕厥的发生， 并明显改善患者的 AHI、 CRP 及咳嗽等相关症状。

Clinical observation of continuous airway positive pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome and cough syncope

Abstract：Objective To observe the curative effect of continuous airway positive pressure ventilation (CPAP) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and cough syncope. Methods Forty-three hospitalized patients with OSAHS and cough syncope were collected in the Department of Respiration of Tianjin General Hospital, and analyzed the related information. They were given CPAP treatment, and were divided into good compliance group (n=26) and poor compliance group (n=17) according to CPAP compliance after a half-year treatment. The apnea hypoventilation index (AHI) and c-reactive protein (CRP) were compared before and after treatment between two groups. Results The positive correlation was found between the frequency of the cough syncope and indicators of OSAHS, such as AHI, body mass index (BMI), CRP, sleepiness score (ESS) and circumference of abdomen and neck (r= 0.612, 0.431, 0.224, 0.654, 0.435 and 0.344，P < 0.05). All these patients were cured after the treatment of both CPAP and medication for 1 or 2 weeks. During a half-year follow-up, the cough syncope didn’ t occur in those patients of good compliance group, otherwise cough syncope still happened but with less frequency in patitents of poor compliance group. Before the treatment , there was no significant difference in AHI (45.00±15.69 vs. 48.70±16.47) and CRP (3.46± 1.15 vs. 3.38±0.72) between the two groups. After treatment, AHI (26.97±14.06 vs. 48.18±15.96) and CRP (1.56±0.76 vs. 3.18± 0.78) were significantly lower in the good compliance group than those of the poor compliance group (P < 0.01). Conclusion Timely and sustained treatment of OSAHS may help reduce the incidence of cough syncope and significantly improve AHI, CRP and cough symptoms.