不同肥胖程度阻塞性睡眠呼吸暂停低通气综合征患者的临床特征研究

背景　肥胖是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的常见危险因素，绝大多数OSAHS患者超重或肥胖，不同肥胖程度的OSAHS患者临床特征可能存在差异。目的　比较不同肥胖程度OSAHS患者的临床特征，进一步明确不同肥胖程度对OSAHS病情的影响。方法　选择自2014年1月-2018年9月在徐州医科大学睡眠医学中心经多导睡眠监测（PSG）检查确诊的OSAHS患者为研究对象，收集患者的临床资料包括一般人口学资料、临床合并症和主要睡眠参数等。参照中国人肥胖标准，根据体质指数（BMI）将OSAHS患者分为正常体质量（<24.0 kg/m2）、超重（24.0~27.9 kg/m2）和肥胖组（≥28.0 kg/m2）。比较三组患者的临床特点、合并症和主要睡眠参数的差异，并分析BMI与主要睡眠参数的相关性。结果　共纳入研究对象1 586例，男1 259例（79.38%），有1 062例（66.96%）吸烟，平均BMI（28.20±4.19）kg/m2。高血压（44.89%，712/1 586）、脑血管疾病（20.62%，327/1 586）、心脏疾病（13.55%，215/1 586）是OSAHS的常见合并症。根据BMI将患者分为正常体质量组206例、超重组616例和肥胖组764例。3组患者年龄、BMI、Epworth嗜睡量表（ESS）评分、合并高血压者占比、合并糖尿病者占比、合并心脏疾病者占比、合并脑血管疾病者占比、氧减饱和指数（ODI）、呼吸暂停低通气指数（AHI）、平均血氧饱和度（MSaO2）、最低血氧饱和度（LSaO2）及微觉醒指数比较，差异有统计学意义（P<0.05）。进一步两两比较可知：超重组患者MSaO2、LSaO2低于正常体质量组（P<0.05），BMI、ODI、AHI及微觉醒指数高于正常体质量组（P<0.05），合并脑血管疾病者占比高于正常体质量组（P<0.016 7）；肥胖组患者平均年龄小于正常体质量组（P<0.05），合并脑血管疾病者占比高于正常体质量组（P<0.016 7）；肥胖组患者MSaO2、LSaO2低于正常体质量组和超重组（P<0.05），BMI、ESS评分、ODI、AHI及微觉醒指数高于正常体质量组和超重组（P<0.05），合并高血压、糖尿病、心脏疾病者占比高于正常体质量组和超重组（P<0.016 7）。Pearson相关分析显示，OSAHS患者BMI与AHI呈线性正相关（r=0.312，P<0.001）；与MSaO2和LSaO2呈线性负相关（r=-0.501和-0.566，P<0.001）。结论　OSAHS患者的BMI与AHI呈正相关，肥胖和超重患者病情重且合并症更多见，提示肥胖增加OSAHS的严重程度。

Clinical Characteristics of Obstructive Sleep Apnea-hypopnea Syndrome Patients with Different Degrees of Obesity

Background　Obesity is a common risk factor for obstructive sleep apnea-hypopnea syndrome （OSAHS）. The vast majority of patients with OSAHS are overweight or obese. Differences may exist in the clinical characteristics of OSAHS patients with different degrees of obesity. Objective　The clinical characteristics of OSAHS patients with different degrees of obesity were compared to determine the influence of different degrees of obesity on OSAHS. Methods　Patients with OSAHS diagnosed by polysomnography（PSG） in Sleep Medical Center of Xuzhou Medical University from January 2014 to September 2018 were selected as research subjects. The clinical data of patients were collected，including demographic data，clinical complications and major sleep parameters. According to the criteria of China Obesity Task Force，OSAHS patients were divided into three groups by their BMI，normal weight group（<24.0 kg/m2），overweight group（24.0-27.9 kg/m2），and obesity group（≥28.0 kg/m2）. The differences of clinical characteristics，comorbidities，and major sleep parameters were compared，and the correlation between BMI and major sleep parameters was analyzed. Results　A total of 1 586 OSAHS patients were included in the study，including 1 259（79.38%） males and 1 062（66.96%） smokers，and the average BMI was（28.20±4.19） kg/m2. Hypertension（44.89%，712/1 586），cerebrovascular disease（20.62%，327/1 586），and heart disease（13.55%，215/1 586） were common complications of OSAHS. According to BMI，206 patients were in the normal weight group，616 were in the overweight group，and 764 were in the obesity group. There were significant differences in age，BMI，Epworth sleepiness scale（ESS） score，hypertension，diabetes，heart disease，cerebrovascular disease，oxygen desaturation index（ODI），apnoea–hypopnoea index（AHI），mean oxygen saturation（MSaO2），lowest oxygen saturation（LSaO2），and microarousal index among patients in three groups（P<0.05）. A further pairwise comparison showed that patients in overweight group had lower MSaO2 and LSaO2 than those in normal weight group（P<0.05），while their BMI，ODI，AHI and microarousal index were higher（P<0.05），and number of cases with cerebrovascular disease was higher（P<0.016 7）. The mean age of patients in obesity group was lower than those of patients in normal weight group（P<0.05），while the number of cases with cerebrovascular disease was higher（P<0.016 7）. MSaO2 and LSaO2 in the obesity group were lower than those in the normal weight group and overweight group（P<0.05），while the BMI，ESS score，ODI，AHI and microarousal index were higher（P<0.05），and number of cases with hypertension，diabetes，and heart disease were higher（P<0.016 7）. Pearson correlation analysis showed that BMI and AHI were linear positively correlated（r=0.312，P<0.001），MSaO2 and LSaO2 were linear negatively correlated （r=-0.501，-0.566； P<0.001）. Conclusion　The BMI of OSAHS patients is positively correlated with AHI. Obese and overweight OSAHS patients showed more severe syndromes and a higher rate of comorbidities. It shows that obesity may aggravate the severity of OSAHS.