Clinical characteristics of obstructive sleep apnea hypopnea syndrome in different genders
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摘要: 目的 探讨OSAHS患者临床特征的性别差异。 方法 4499例OSAHS患者经PSG监测和Epworth嗜睡量表(ESS)测评，按OSAHS严重程度分为轻、中、重度3组，对男、女性患者的结果进行比较，并行亚组分析。 结果 女性OSAHS患者ESS评分[中位数(四分位间距)]8.0(4.0，13.0)低于男性10.0(5.0，15.0)，差异有统计学意义(P < 0.05)，中、重度组男女性患者ESS评分差异均有统计学意义(P < 0.05)；女性AHI为22.8(11.6，43.1)，明显低于男性35.7(16.5，61.3)；女性患者较男性年龄大，颈围小，BMI小，LSaO2更高(P < 0.05)，且上述差异在重度组中最为明显(P < 0.05)；男女性患者在OSAHS轻、中、重度组中分布比例均有差异。 结论 男女性患者的发病年龄、日间嗜睡程度、颈围、BMI、LSaO2、睡眠时间及OSAHS严重程度均有不同，提示OSAHS发病具有性别差异，临床上应更重视女性的不典型症状，从而积极干预，改善其预后。
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关键词:
- 睡眠呼吸暂停低通气综合征，阻塞性 /
- ESS量表 /
- 性别差异
Abstract: Objective To explore the gender difference of clinical features in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and explore the relationship between OSAHS and gender. Methods 4499 patients with OSAHS were examined by polysomnography (PSG) and Epworth sleepiness scale (ESS). Subjects were divided into mild, moderate and severe groups according to the severity of OSAHS. The results were compared and analyzed between male and female patients. Results The ESS score of female patients was lower than that of male, and difference was still significant in moderate and severe subgroups[8.0(4.0, 13.0) vs 10.0(5.0, 15.0), P < 0.05]. The apnea hypopnea index(AHI) of female patients was significantly lower than that of male patients[22.8(11.6, 43.1) vs 35.7(16.5, 61.3), P < 0.05]. Compared with male patients, female patients had older age, smaller neck circumference, smaller body mass index(BMI) and higher lowest oxygen saturation (LSaO2), and the difference mentioned above was most significant in severe subgroup(P < 0.05). Difference was also found in the distribution of severity between male and female patients. Conclusion The age of onset, daytime sleepiness, neck circumference, BMI index, lowest blood oxygen saturation, sleep time and OSAHS severity are different between male and female, suggesting that there are gender differences in OSAHS patients. Therefore, in clinical diagnosis and treatment of female patients, more attention should be paid to atypical symptoms, and the ESS scale should be modified to improve the diagnostic sensitivity of female OSAHS patients, to actively intervene and improve their prognosis. -
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表 1 ESS量表评分和PSG监测结果
性别 ESS评分 睡眠时间/min AHI LSaO2 男性 10.0(5.0，15.0)1) 411.5±63.61) 35.7(16.5，61.3)1) 78.0(64.0，85.0)1) 女性 8.0(4.0，13.0) 395.3±59.6 22.8(11.6，43.1) 82.0(73.0，86.0) 与女性比较，1) P < 0.01。 
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表 2 OSAHS轻、中、重度亚组分析
项目 轻度(n=1092例)) 中度(n=995例) 重度(n=2412例) 男(n=899例) 女(n=193例) 男(n=848例) 女(n=147例) 男(n=2198例) 女(n=214例) ESS评分 8.0(4.0, 12.0)3) 7.0(3.0, 12.0)3) 8.0(4.0, 13.0)3) 6.0(3.0, 10.0)3) 11.0(6.0, 16.0)1)2) 9.0(3.0, 13.8)1)2) AHI 9.6(6.8, 12.2)2)3) 9.2(7.0, 12.1)2)3) 21.6(18.2, 25.7)1)3) 21.8(17.5, 25.1)1)3) 58.2(44.1, 72.3)1)2) 49.0(38.8, 70.7)1)2) 年龄/岁 44.3±12.92) 52.8±11.13) 47.1±13.01)3) 55.7±11.6 44.3±11.32) 55.5±11.81) 颈围/cm 40.4±2.82)3) 35.8±2.83) 40.8±3.11)3) 36.2±3.23) 42.6±3.01)2) 37.9±3.41)2) BMI 26.7±3.12)3) 26.2±3.53) 27.3±3.41)3) 26.9±4.33) 29.4±3.91)2) 28.9±5.21)2) LSaO2/% 86.0(83.0, 89.0)2)3) 87.0(82.0, 89.0)2)3) 83.0(78.0, 86.0)1)3) 83.0(79.0, 86.0)1)3) 67.0(58.0, 77.0)1)2) 73.0(60.0, 80.0)1)2) 睡眠时间/min 397.5±61.63) 393.6±61.4 397.1±62.53) 387.0±52.3 422.8±62.71)2) 402.6±62.0 与同性别中度组比较，1)P < 0.05；与同性别中度组比较, 2)P < 0.05; 与同性别重度组比较，3)P < 0.05。
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表 3 男女患病严重程度差异比较
例(%) 性别 轻度 中度 重度 χ2 P 男性 899(22.8) 848(21.5) 2198(55.7) 60.950 0.000 女性 193(34.8) 147(26.5) 214(38.6)
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