影响成人阻塞性睡眠呼吸暂停低通气综合征患者生活质量因素分析

目的 对影响成人OSAHS患者生活质量的因素进行分析.方法 收集OSAHS患者共59例,均进行多导睡眠监测并填写ESS嗜睡量表及《成人用阻塞性睡眠呼吸暂停低通气综合征患者生命质量评估表》(QOL-OSAHS).记录睡眠呼吸暂停低通气指数(AHI)、呼吸暂停总时间(AP 总时间)、最长呼吸暂停时间、呼吸暂停平均时间、呼吸暂停及低通气时间指数(AHTI)、最低血氧饱和度、90％以下血氧饱和度指数、90％以下血氧饱和度次数、血氧饱和度下降的时间、血氧饱和度低于90％的时间占睡眠时间的比例(TST90),采用多元线性回归分析及判别分析进行检验.结果 ①呼吸指标中筛选出AP总时间与生活质量关系密切,与生活质量量表综合评分、EP评分、症状维度、日常工作生活维度及社会关系维度相对应的标准回归系数分别是:-0.326、0.544、-0.531、-0.282、-0.303,P值均＜0.05,差异有统计学意义.②血氧饱和度指标:SaO2下降的总时间和生命质量量表综合评分、EP评分、症状维度、日常工作生活维度相对应的标准回归系数分别是:-0.599、0.696、-0.754、-0.469,P值均＜0.05,差异有统计学意义;TST90会影响到生命质量量表中社会关系维度,标准相关系数是-0.263 (P＜0.05).最低SaO2和生活质量量表中的综合评分、EP评分、症状维度、日常生活工作维度及警觉维度的标准回归系数分别是:-0.378、0.310、-0.318、-0.326、-0.263,P值均＜0.05,差异有统计学意义.③应用判别分析得到的方程:轻度OSAHS=-59.676+ 1.537(最低SaO2)-0.01(SaO2下降的总时间)+91.848 (TST90);中度OSAHS=-63.391+ 1.58(最低SaO2)-0.01(SaO2下降的总时间)+104.711 (TST90);重度OSAHS=-68.300-0.000044(AP总时间)+1.618(最低SaO2)-0.01(SaO2下降总时间)+79.883 (TST90).上述方程对轻、中、重的判别正确率分别是:73.3％、38.5％、76.5％.结论 AP总时间、SaO2下降的总时间、TST90和最低SaO2从不同的方面影响患者的生活质量,在评价OSAHS患者病情程度时应将这四个指标纳入考虑范围.

Analysis of factors affecting the quality of life in patients with obstructive sleep apnea hypopnea syndrome

Objective To analyze the factors affecting the quality of life in patients with OSAHS.Methods Fifty-nine patients who were dignosed OSAHS were collected and asked to fill in the ESS and the QOL-OSAHS.Their names,sex,height,weight,EP scores,total scores of the QOL-OSAHS and the score in every dimensionality (symptom,daily working and living,social relationship,alertness and motion) were also recorded.The results of the polysomnography were also evaluated,which included AHI,the total time of AP,the longest time of AP,the mean time of AP,AHTI,the lowest SaO2,the index of SaO2 below 90％,the times of SaO2 below 90％,the total time of SaO2 below 90％ and the TST90.We used linear correlation analysis,multiple linear regression analysis and discriminant analysis.Results Firstly,the total time of AP was selected from the breath indexes,because it would impact patients,quality of life and symptoms.The regression coefficients between the total time of AP and the total scores of the QOL-OSAHS,EP scores,symptoms dimensionality,daily working and living dimensionality and social relationship dimensionality were-0.326,0.544,-0.531,-0.282 and-0.303 (P ＜0.05),respectively.Secondly,in the SaO2 indexes,three indexes were found to impact quality of life and symptoms.They were the total time of SaO2 below 90％,the lowest SaO2 and TST90.The regression coefficients between the total time of SaO2 below 90％ and the total scores of QOL-OSAHS,EP scores,symptoms dimensionality and daily working and living dimensionality were-0.599,0.696,-0.754 and -0.469(all P ＜ 0.05),respectively.The regression coefficients between TST90 and social relationship was-0.263(all P ＜0.05).The regression coefficients between the lowest SaO2 and the total scores of QOL-OSAHS,EP scores,symptoms dimensionality,the daily working and living dimensionality and alertness dimensionality were-0.378,0.310,-0.318,-0.326 and-0.263 (all P ＜ 0.05).Thirdly,three equations could be established to compute the degree of OSAHS.The equation for the mild OSAHS was-59.676+ 1.537 (the lowest SaO2)-0.01 (the total time of SaO2 below 90％) +91.848(TST90).The equation for the modest OSAHS was-63.391+ 1.58 (the lowest SaO2)-0.01 (the total time of SaO2 below 90 ％) + 104.711 (TST90).The equation for the severe OSAHS was-68.300-0.000044 (the total time of AP) + 1.618 (the lowest SaO2)-0.01 (the total time of SaO2 below 90 ％) + 79.883 (TST90).The discriminant accuracy of the three equations were 73.3％,38.5％ and 76.5％.Conclusions It was demonstrated in the present study that the total time of AP,SaO2 below 90％,TST90 and the lowest SaO2 would affect the quality of patients with OSAHS in various aspects,therefore the four indexes should be take into account in judging the severity.