降低体质量对阻塞性睡眠呼吸暂停低通气综合征治疗的研究

目的探讨降低体质量对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）伴超重或肥胖者治疗的影响及临床意义。方法采用低热量饮食（84～105kJ／kg）和（或）运动减重后，观察治疗组与对照组自体症状、睡眠监测及血液生化等各项指标的变化情况，并对年龄、性别、治疗前体质量指数（BMI）、呼吸暂停低通气指数（AHI）、吸烟、高血压、糖尿病、高血脂、脑梗死、服药多因素进行Logistic回归分析。结果治疗组与对照组前后差值比较，鼾声、嗜睡评分、憋气、憋醒、记忆力下降、全身不适、胸闷、心悸症状均有改善；颈围、腰围、臀围较对照组有明显差异；呼吸暂停次数、AHI、呼吸暂停指数（AI）也较对照组有明显差异；低通气次数及低通气指数（Hl）无明显差异。血氧饱和度（SaO2低于95％、低于85％及低于80％所占的时间百分比较对照组有明显差异；最低血氧饱和度（LSaO2）及最长呼吸暂停时间较对照组有显著性差异。红细胞（RBC）、血红蛋白（Hb）、红细胞压积（HCT）也有明显差异。Logistic回归分析表明BMI、体质量减少、脑梗死、高脂血症影响OSAHS伴超重或肥胖者的治疗效果。结论减重对OSAHS伴超重或肥胖者的治疗是有效的，可使OSAHS者的严重程度得到改善，并使部分轻度OSAHS者治愈。减重后缺氧、RBC的改善对预防心脑血管病有着重要的意义。

Investigation on weight loss treatment for obstructive sleep apnea hypopnea syndrome

Objective To investigate the effect and clinical significance of weight loss for obese or overweight patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Following weight loss treatment by low - calorie diet （84 - 105 kJ/kg） or physical exercise, the symptoms and the parameters change of sleep monitoring and blood biochemical tests were compared between treatment group and control group. Logistic regression analysis was performed on age, sex, body mass index （BMI）, apnea hypopnea index （AHI） before treatment, history of smoking, hypertension, diabetes, hyperlipidemia, cerebral infarction and medication. Results Compared with control group, the snoring, sleepiness score, apnea, arousal, declined memory, general malaise, chest distress, and palpitation were significantly improved in treatment group, while there was a remarkable difference in circumferences of neck, waist and hip, as well as in apnea times, AHI and apnea index （AI）. The percentage of time with SaO2 lower than 95% , 85% ,and 80% , the minimal SaO2 and the longest duration of apnea events, as well as the count of red blood cells （ RBC ）, hemoglobin and hemocrit of RBC in treatment group were significantly different from those in control group. Logistic regression analysis indicated that the treatment efficacy in obese or overweight OSAHS patients was influenced by BMI, weight loss, cerebral infarction and hyperlipidemia. Conclusions Weight loss is an effective treatment method for obese or overweight OSAHS, which is demonstrated by improvement in the severity of OSAHS and complete recovery in some mild OSAHS patients. Improvement of hypoxia and RBC count following weight loss treatment is of important significance for prevention of cerebrocardiovascular diseases.