Analysis of influencing factors of excessive daytime sleepiness in adults with different degrees of sleep-disordered breathing
-
摘要: 目的 分析成人不同程度睡眠呼吸紊乱(SDB)患者白天过度嗜睡(EDS)的主要影响因素，为SDB的个性化诊治提供科学依据。方法 回顾性分析行PSG监测的361例中青年打鼾患者的临床资料，按是否伴有阻塞性睡眠呼吸暂停(OSA)以及AHI水平分为单纯打鼾(AHI < 5)、轻度OSA(AHI 5~ < 15)，中度OSA(AHI 15~ < 30)和重度OSA(AHI≥30)，从睡眠效率、不同睡眠分期(REM、NREM1、NREM2、NREM3)占总睡眠比率、氧减指数(ODI)、血氧饱和度 < 90%时间占睡眠总时间的百分比(TS90%)、整夜睡眠平均血氧饱和度(MSaO2)和最低血氧饱和度(LSaO2)以及不同睡眠分期呼吸暂停低通气指数(REM-AHI、NREM-AHI)、不同睡眠分期平均血氧饱和度(REM-MSaO2、NREM-MSaO2)和不同睡眠分期最低血氧饱和度(REM-LSaO2、NREM-LSaO2)等方面探讨EDS的主要影响因素。结果 361例患者中，单纯打鼾23例，轻度OSA 47例，中度OSA 56例，重度OSA 235例。单纯打鼾患者中，EDS人群的REM-AHI为10.9、ODI为9.6、TS90%为0.2，均显著高于无EDS人群(P < 0.01)，EDS的主要影响因素为REM-AHI、ODI和TS90%;但在轻度OSA患者中，EDS人群的REM-AHI为29.6，显著高于无EDS人群(P < 0.05)，EDS的主要影响因素为REM-AHI; 中度OSA患者中，EDS人群的LSaO2为76.2，显著低于无EDS组(P < 0.05)，EDS的主要影响因素为LSaO2; 重度OSA患者中，EDS人群的BMI、ODI和TS90%显著高于无EDS人群(P < 0.05或P < 0.01)，而NREM-MSaO2、MSaO2和LSaO2则显著低于无EDS人群(P < 0.05或P < 0.01)，EDS的主要影响因素为BMI、NREM-MSaO2、MSaO2、LSaO2、ODI和TS90%。结论 REM期频繁发生的呼吸暂停可能是引起单纯打鼾和轻度OSA患者EDS的重要因素之一; 而对中重度OSA患者，夜间间歇低氧可能成为导致患者EDS的主要因素，肥胖对病情发展和嗜睡发生有促进作用。
-
关键词:
- 睡眠呼吸暂停，阻塞性 /
- 睡眠呼吸紊乱 /
- 白天过度嗜睡
Abstract: Objective To explore the main influencing factors of excessive daytime sleepiness(EDS) in adults with different degrees of sleep-disordered breathing(SDB), which will provide the scientific evidences for the individualized diagnosis and treatment.Method Retrospective analysis was performed on the clinical data of 361 young and middle-aged snoring patients monitored by polysomnography. According to the presence or absence of obstructive sleep apnea(OSA) and apnea hypopnea index(AHI) levels, they were divided into primary snoring(AHI < 5), mild OSA(AHI 5- < 15), moderate OSA(AHI 15- < 30) and severe OSA(AHI≥30). From sleep efficiency(ES), different sleep stages(REM, NREM1, NREM2, NREM3) ratio of total sleep, oxygen reduction index(ODI), blood oxygen saturation < 90% of total sleep time(TS90%), the average saturation of blood oxygen(MSaO2) and the lowest blood oxygen saturation(LSaO2) of all-night sleep, and AHI in different sleep stages(REM-AHI, NREM-AHI), MSaO2in different sleep stages(REM-MSaO2, NREM-MSaO2) and LSaO2in different sleep stages(REM-LSaO2, NREM-LSaO2), the main influencing factors of EDS were discussed.Result Among the 361 patients, 23 patients suffered from the primary snoring, 47 patients with mild OSA, 56 patients with moderate OSA, and 235 patients with severe OSA. REM-AHI, ODI and TS90% in EDS group were 10.9, 9.6 and 0.2 respectively in patients with primary snoring, which were significantly higher than those without EDS(P < 0.01). The main influencing factors of EDS were REM-AHI, ODI, and TS90%. However, among patients with mild OSA, REM-AHI was the main influencing factor of EDS, REM-AHI of the EDS group was 29.6, which was significantly higher than that of the non-EDS(P < 0.05). In patients with moderate OSA, LSaO2of the EDS group was 76.2, significantly lower than the group without EDS(P < 0.05), the main influencing factor of EDS is LSaO2. In patients with severe OSA, BMI, ODI and TS90% in EDS group were significantly higher than those without EDS(P < 0.05 or P < 0.01), while NREM-MSaO2, MSaO2and LSaO2were significantly lower than those without EDS(P < 0.05 or P < 0.01). The main influencing factors of EDS were BMI, NREM-MSaO2, MSaO2, LSaO2, ODI and TS90%.Conclusion Frequent apnea during REM stage may be one of the important factors causing EDS in patients with primary snoring and mild OSA. For patients with moderate and severe OSA, intermittent hypoxia at night may be the main factor leading to EDS, and obesity may promote the development of the disease and the occurrence of sleepiness. -
-
表 1 不同程度的成人SDB患者平均年龄及性别比较
x±s 程度分级 年龄 男性 女性 单纯打鼾 38.6±11.2 20(87.0) 3(13.0) 轻度OSA 40.4±10.0 40(85.1) 7(14.9) 中度OSA 40.2±10.2 50(89.3) 6(10.7) 重度OSA 38.8±9.2 207(88.1) 28(11.9) 
下载: 导出CSV
表 2 不同程度的成人SDB患者EDS的比例
例(%) 程度分级 例数 无EDS 有EDS 单纯打鼾 23 5(21.7) 18(78.3) 轻度OSA 47 18(38.3) 29(61.7) 中度OSA 56 21(37.5) 35(62.5) 重度OSA 235 113(48.1) 122(51.9)
下载: 导出CSV
表 3 BMI对不同程度的成人SDB患者EDS的影响
x±s 指标 无EDS 有EDS P 单纯打鼾 22.9±5.2 25.0±1.3 0.39 轻度OSA 25.6±2.9 26.7±3.6 0.24 中度OSA 26.4±4.4 26.0±3.2 0.75 重度OSA 27.7±4.0 28.9±3.3 0.02
下载: 导出CSV
表 4 不同程度的SDB成人EDS的影响因素分析
例(%) 变量 单纯打鼾(n=23) 轻度OSA(n=47) 中度OSA(n=56) 重度OSA(n=235) 无EDS (n=18) 有EDS (n=5) 无EDS (n=29) 有EDS (n=18) 无EDS (n=35) 有EDS (n=21) 无EDS (n=122) 有EDS (n=113) BMI 22.9(5.2) 25.0(1.3) 25.6(2.9) 26.7(3.6) 26.4(4.4) 26.0(3.2) 27.7(4.0) 28.9(3.3)1) REM-AHI 2.0(2.8) 10.9(16.5)1) 18.1(15.8) 29.6(13.7)1) 34.3(15.7) 33.1(20.9) 53.2(20.8) 54.6(16.4) AHI 1.7(1.3) 3.6(1.1)1) 9.3(3.0) 11.4(2.1)1) 20.6(3.8) 21.9(4.3) 56.6(18.1) 59.7(15.6) NREM-MSaO2 96.5(1.0) 95.8(1.3) 95.0(2.4) 95.1(1.3) 95.1(1.5) 94.3(3.8) 92.2(4.2) 90.9(4.5)1) MSaO2 96.6(1.0) 95.8(1.3) 95.2(2.2) 95.3(1.1) 95.0(1.5) 94.3(3.8) 92.2(4.3) 90.7(4.7)1) LSaO2 90.7(1.6) 89.2(4.7) 85.1(4.7) 82.3(4.9) 81.9(5.1) 76.2(14.8)1) 70.9(13.6) 63.9(15.4)2) ODI 3.9(2.4) 9.6(6.2)2) 14.7(7.6) 17.8(7.0) 29.1(9.4) 30.2(15.7) 60.3(20.3) 66.7(16.9)1) TS90% 0.0(0.0) 0.2(0.3)1) 5.3(19.6) 1.3(1.9) 2.8(4.6) 7.0(21.3) 19.4(22.3) 28.5(22.3)2) 与无EDS比较，1)P<0.05，2)P<0.01。
下载: 导出CSV
-
[1] 叶京英. 睡眠呼吸障碍诊断和治疗的进展与发展方向[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(6): 483-485. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201506001.htm
[2] Roth T, Rosenberg RP. Managing excessive daytime sleepiness[J]. J Clin Psychiatry, 2015, 76(11): 1518-1521. doi: 10.4088/JCP.14019co5c
[3] 陈曦, 章榕, 王洪洪, 等. Epworth嗜睡量表和微觉醒指数在重度OSAHS患者病情评估中的价值[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(3): 167-169. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201703001.htm
[4] Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta-analysis[J]. Sleep Med Rev, 2014, 18(1): 61-73. doi: 10.1016/j.smrv.2013.01.004
[5] Mulgrew AT, Ryan CF, Fleetham JA, et al. The impact of obstructive sleep apnea and daytime sleepiness on work limitation[J]. Sleep Med, 2007, 9(1): 42-53. doi: 10.1016/j.sleep.2007.01.009
[6] Swanson LM, Arnedt JT, Rosekind MR, et al. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll[J]. J Sleep Res, 2011, 20(3): 487-494. doi: 10.1111/j.1365-2869.2010.00890.x
[7] He K, Kapur VK. Sleep-Disordered Breathing and Excessive Daytime Sleepiness[J]. Sleep Med Clin, 2017, 12(3): 369-382. doi: 10.1016/j.jsmc.2017.03.010
[8] Lagrotte C, Fernandez-Mendoza J, Calhoun SL, et al. The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: a longitudinal, population-based study[J]. Int J Obes(Lond), 2016, 40(9): 1397-1404. doi: 10.1038/ijo.2016.87
[9] Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study[J]. Lancet Respir Med, 2015, 3(4): 310-318. doi: 10.1016/S2213-2600(15)00043-0
[10] Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults[J]. N Engl J Med, 1993, 328(17): 1230-1235. doi: 10.1056/NEJM199304293281704
[11] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective[J]. Am J Respir Crit Care Med, 2002, 165(9): 1217-1239. doi: 10.1164/rccm.2109080
[12] Chervin RD, Aldrich MS. Characteristics of apneas and hypopneas during sleep and relation to excessive daytime sleepiness[J]. Sleep, 1998, 21(8): 799-806.
[13] Punjabi NM, Bandeen-Roche K, Marx JJ, et al. The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep[J]. Sleep, 2002, 25(3): 307-314.
[14] Chen R, Xiong KP, Lian YX, et al. Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients[J]. Sleep Breath, 2011, 15(1): 129-135. doi: 10.1007/s11325-010-0337-4
[15] Sun Y, Ning Y, Huang L, et al. Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome[J]. Sleep Breath, 2012, 16(2): 375-381. doi: 10.1007/s11325-011-0515-z
[16] Corlateanu A, Pylchenko S, Sircu V, et al. Predictors of daytime sleepiness in patients with obstructive sleep apnea[J]. Pneumologia, 2015, 64(4): 21-25.
[17] Wu MN, Lai CL, Liu CK, et al. More severe hypoxemia is associated with better subjective sleep qualityin obstructive sleep apnea[J]. BMC Pulm Med, 2015, 15: 117. doi: 10.1186/s12890-015-0112-1
-