Factors influencing severity variability in obstructive sleep apnea and the role of fluid shift
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摘要: 目的 阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)在前后半夜测得的呼吸暂停低通气指数(apnea-hypopnea index，AHI)变异较大。可能与睡眠时卧位导致的体液再分布有关。方法 纳入成人受试者89例。在入睡前和清醒后测量4围(颈围、胸围、腹围及小腿围)。完成多导睡眠监测(polysomnography，PSG)，并根据整夜睡眠期中点划分前后半夜，计算分夜AHI。分析AHI变化与4围变化的相关性。结果 纳入单纯打鼾者20例，OSAHS患者69例，中位AHI=22.6(11.8，47.3)次/时。较入睡前，清醒后对照组颈围无显著性改变(P=0.073)，其余3围降低(P=0.006，P=0.038，P < 0.001)。OSAHS患者组颈围升高(P < 0.001)，其余3围降低(P < 0.001，P < 0.001，P < 0.001)，以小腿围改变最为显著40.0(37.1，42.0) cm~38.0(35.8，40.5) cm。比较于前半夜，后半夜总AHI、仰卧位AHI、NREM期AHI均显著降低(P=0.010，P=0.031，P=0.001)，侧卧位AHI、REM期AHI无显著改变(P=0.988，P=0.530)。进一步分析发现，胸围增加与NREM期AHI、仰卧位AHI及仰卧位NREM期AHI减少有显著关系(P=0.036，P=0.072，P=0.034)，侧卧位AHI减少与腹围增加有显著关系(P=0.048)。此外，本研究发现小腿围变化值与AHI变化值呈负相关(R=-0.24，P=0.048)，而颈围变化与AHI变化呈正相关(R=0.26，P=0.03)。结论 后半夜睡眠的胸围、腹围及小腿围较睡前降低，颈围升高。AHI、仰卧位AHI和NREM期AHI降低；胸围的增加与NREM期AHI、仰卧位AHI及仰卧位NREM期AHI减少有关。OSAHS患者存在夜间AHI变异性，且夜间AHI变异性可能与睡眠时体液的转移有关。
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关键词:
- 睡眠呼吸暂停，阻塞性 /
- 诊断 /
- 颈围 /
- 液体迁移
Abstract: Objective The variability of the apnea-hypopnea index(AHI) measured in the first and second halves of the night is significant in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). This variation may be related to fluid redistribution caused by the supine position during sleep.Methods Eighty-nine adult subjects were enrolled. Circumferences(neck, chest, waist, and calf) were measured before sleep onset and upon awakening. Polysomnography(PSG) was performed, and the night was divided into two halves based on the midpoint of total sleep time to calculate AHI for each half. The correlation between changes in AHI and changes in circumferences was analyzed.Results Twenty simple snorers and sixty-nine OSAHS patients were included, with a median AHI of 22.6(11.8, 47.3) events/hour. Compared to pre-sleep measurements, there was no significant change in neck circumference upon awakening in the control group(P=0.073), while reductions were observed in the other three measurements(P=0.006, P=0.038, P < 0.001). In the OSAHS group, neck circumference increased(P < 0.001), and reductions were noted in the other three measurements(P < 0.001 for all), with the most significant change observed in calf circumference 40.0(37.1, 42.0) cm to 38.0(35.8, 40.5) cm. Compared to the first half of the night, total AHI, supine AHI, and NREM AHI significantly decreased in the second half(P=0.010, P=0.031, P=0.001), while no significant changes were observed in lateral AHI and REM AHI(P=0.988, P=0.530). Further analysis revealed a significant relationship between increased chest circumference and decreases in NREM AHI, supine AHI, and supine NREM AHI(P=0.036, P=0.072, P=0.034), as well as between decreased lateral position AHI and increased waist circumference(P=0.048). Additionally, this study found a negative correlation between changes in calf circumference and changes in AHI(R=-0.24, P=0.048), while neck circumference changes positively correlated with changes in AHI(R=0.26, P=0.03).Conclusion In OSAHS patients during the second half of sleep compared to before sleeping, chest circumference, waist circumference, and calf circumference decrease while neck circumference increases; total AHI, supine position AHI, and NREM period AHI decrease; increases in chest circumference are associated with decreases in NREM period AHI, supine position AHI, supine position NREM period AHI. There is nocturnal variability in AHI among OSAHS patients that may be associated with fluid shifts during sleep.-
Key words:
- sleep apnea syndromes, obstructive /
- diagnosis /
- neck circumference /
- fluid shift
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表 1 受试者一般情况
M(P25，P75) 项目 OSAHS患者(n=69) 单纯打鼾者(n=20) 性别(男︰女)/例 56︰13 12︰8 年龄/岁 39.0(31.5，50.0) 31(26.3，38.8) BMI/kg/m2 25.8(23.7，28.1) 23.4(19.5，24.8) AHI/次/h 22.6(11.8，47.3) 1.0(0.3，2.2) OAI/次/h 10.8(3.0，33.5) 0(0，0.4) REM期AHI/次/h 30.7(15.4，48.2) 1.5(0，4.9) 仰卧位AHI/次/h 33.0(14.3，59.6) 1.3(0.6，3.6) 最低血氧 83.0(75.0，88.5) 94.0(91.3，95.0) 氧减指数/次/h 15.1(7.0，43.0) 0.3(0，0.6) CT90 0.4(0.1，5.8) 0(0，0) 入睡前颈围/cm 40.0(38.0，41.3) 36.5(32.9，39.8) REM为快动眼睡眠期。 
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表 2 OSAHS患者及单纯打鼾患者入睡前及清醒后躯体围度比较
M(P25，P75) 项目 单纯打鼾者 OSAHS患者 入睡前 清醒后 入睡前 清醒后 颈围 36.5(32.9，39.8) 35.9(33.0，40.0) 40.0(38.0，41.3) 40.5(38.0，42.0)2) 胸围 94.3(88.3，101.1) 91.6(84.9，97.4)1) 100.0(96.7，104.3) 99.0(95.3，103.0)2) 腰围 84.3(73.3，91.1) 83.5(73.3，91.0)1) 96.0(91.0，103.3) 95.0(90.0，101.0)2) 小腿围 38.5(36.1，41.5) 36.7(33.9，39.8)2) 40.0(37.1，42.0) 38.0(35.8，40.5)2) 与入睡前比较，1)P < 0.05, 2)P < 0.01。
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