Analysis of the effect of noninvasive positive-pressure ventilation with simultaneous detection of Dx-pH monitoring in oropharynx and esophagus for 48 hours in patients with moderate and severe OSA
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摘要: 目的 探讨无创正压机械通气(NPPV)治疗对中、重度阻塞性睡眠呼吸暂停(OSA)患者胃食管反流(GER)、咽喉反流(LPR)相关指标的影响。方法 回顾性分析23例中、重度OSA并可疑咽喉反流性疾病(LPRD)患者连续48 h口咽及食管pH监测并同步多导睡眠监测(PSG)及NPPV治疗结果，探讨LPR、GER与睡眠通气障碍的关系，并与NPPV治疗当晚反流相关数据比较，分析NPPV对反流的影响。结果 第1天Dx-pH监测，Ryan阳性诊断LPRD 5例，阳性率21.7%；以pH 6.0为阈值，存在≥1次夜间反流事件19例，阳性率82.6%；DeMeester积分阳性诊断胃食管反流病(GERD)10例，阳性率43.5%。口咽及食管最低pH值与阻塞性呼吸事件指数(OAI)呈负相关(r=-0.557，P=0.007；r=-0.447，P=0.037)，口咽pH6.0反流总次数、食管最长反流时间与呼吸暂停低通气指数(r=0.595，P=0.004；r=0.436，P=0.043)及OAI均呈正相关(r=0.520，P=0.013；r=0.528，P=0.012)。NPPV治疗当晚口咽部最低pH值较前升高，pH6.0反流总次数及pH5.0反流百分比时间较前下降(P < 0.05)；食管远端最低pH值及平均pH值较前升高(P < 0.05)，酸反流总次数、酸反流百分比时间、最长反流时间均下降(P < 0.05)。结论 OSA患者夜间伴有较高的GER发病率，并合并一定程度的LPR。NPPV治疗不仅可有效改善GER，还可以一定程度减轻LPR。
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关键词:
- 睡眠呼吸暂停，阻塞性 /
- 咽喉反流性疾病 /
- 胃食管反流病 /
- 无创正压机械通气 /
- pH监测
Abstract: Objective To investigate the effect of noninvasive positive-pressure ventilation(NPPV) on the related indexes of gastroesophageal reflux(GER) and laryngopharyngeal reflux(LPR) in patients with moderate and severe obstructive sleep apnea(OSA).Method This was a retrospective study of 23 cases with moderate or severe OSA and suspected laryngopharyngeal reflux disease(LPRD). The results of 48h-pH monitoring of oropharynx and esophagus, polysomnography(PSG) and NPPV were analyzed to explore the relationship between reflux related parameters and sleep disordered respiratory. To analyze the impact of NPPV on reflux, the data related to nocturnal reflux with or without NPPV treatment was compared.Result On the first day of Dx-pH, 5 cases of LPRD were diagnosed with a positive Ryan score rate of 21.7%. There were 19 cases(82.6%) with more than one nocturnal reflux event with pH6.0 as the threshold. Ten cases of GERD were diagnosed with a positive DeMeester score rate of 43.5%. The lowest pH value of oropharynx and esophagus was negatively correlated with the obstructive apnea index(OAI). The total number of reflux episodes falling below pH thresholds of 6.0 and the duration of the longest episode of gastroesophageal reflux were positively correlated with AHI and OAI(P < 0.05). On the night of NPPV treatment, the lowest pH value in the oropharynx increased, while the total number of reflux episodes below pH6.0 and the percentage time below pH5.0 decreased(P < 0.05). Similar significant difference was found in the GER parameters(P < 0.05).Conclusion OSA patients were associated with a higher incidence of GER at night and a certain degree of LPR. NPPV treatment can not only effectively improve GER, but also reduce LPR to a certain extent. -
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表 1 第1晚与第2晚主要睡眠参数分析
x±s 项目 AHI LSaO2/% t P 第1晚 53.2±25.5 71.5±11.9 9.516 ＜0.001 第2晚 6.6±6.3 88.9±8.4 -7.986 ＜0.001 
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表 2 Ryan阳性患者咽部pH数据分析
Ryan阳性患者 第1天 第2天 总例数 5 5 立位阳性例数 4 5 卧位阳性例数 3 1 立、卧位均阳性例数 2 1 第1天卧位阳性Ryan值 病例1 19.00 2.17 病例2 14.37 14.34 病例3 11.64 2.17
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表 3 所有患者夜间睡眠时咽部pH监测数据分析
M(P25，P75) 反流参数 第1晚 第2晚 Z P 最低pH值 5.49(5.12，5.89) 5.69(5.30，6.05) -2.281 0.023 平均pH值 6.11(5.98，6.41) 6.26(6.03，6.58) -0.114 0.910 pH6.0 酸反流总次数 128.00(38.00，245.00) 63.00(18.00，134.00) -2.294 0.022 AET/% 16.03(0.65，25.39) 11.80(4.23，21.80) -0.402 0.687 最长反流时间/min 32.07(1.56，46.62) 37.04(5.88，70.04) -1.502 0.133 pH5.0 酸反流总次数 0.00(0.00，0.00) 0.00(0.00，0.00) -1.214 0.225 AET/% 0.00(0.00，0.00) 0.00(0.00，0.00) -1.992 0.046 最长反流时间/min 0.00(0.00，0.00) 0.00(0.00，0.00) -0.943 0.345
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表 4 所有患者夜间睡眠时远端食管pH监测数据分析
M(P25，P75) 反流参数 第1晚 第2晚 Z P 最低pH值 3.16(2.10，5.06) 4.65(2.54，5.50) -2.342 0.019 平均pH值 6.44(6.03，6.72) 6.74(6.48，6.89) -2.768 0.006 酸反流总次数 4.00(0.00，35.00) 0.00(0.0，12.75) -2.095 0.036 AET/% 0.06(0.00，2.35) 0.00(0.00，0.37) -2.017 0.044 最长反流时间/min 0.00(0.00，4.00) 0.00(0.00，2.00) -2.006 0.045 反流超过5 min次数 0.00(0.00，0.00) 0.00(0.00，0.00) -1.625 0.104
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