便携式睡眠监测对阻塞性睡眠呼吸暂停低通气患者整夜病情评估及心血管疾病风险因素分析

doi:10.19983/j.issn.2096-8493.2024132

摘要/Abstract

摘要：

目的：采用便携式睡眠监测探索阻塞性睡眠呼吸暂停的整夜病情评估指标及心血管疾病风险预测指标。方法：采用回顾性、临床病例分析,对2019年5月至2020年7月192例门诊及住院患者进行筛查。记录患者身体测量指标、血压及既往病史等,记录患者的生化检测指标。采用Phillip Alice Night One便携式多导睡眠监测仪进行呼吸睡眠监测,监测过程采集数据包括呼吸暂停低通气指数(apnea hypopnea index, AHI)、最长暂停时间、最长低通气时间、最低血氧饱和度、平均血氧饱和度、整夜血氧饱和度低于90%时间比、整夜暂停时间占睡眠比、整夜低通气时间占睡眠时间比、艾普沃斯嗜睡量表评分(Epworth sleepiness scale, ESS),探索阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)患者整夜睡眠评估指标。根据纳入和排除标准纳入152例OSAHS患者,通过China-PAR模型,进行10年动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease, ASCVD)风险评估。结果：179例患者诊断为OSAHS,OSAHS患者的最低血氧饱和度、最长暂停时间与AHI呈负相关(OR=0.84,P=0.002;OR=0.96,P=0.017),整夜暂停时间占睡眠时间比、整夜低通气时间占睡眠时间比与AHI分级呈正相关(OR=1.89,P<0.001;OR=2.23,P<0.001)。重度AHI患者的整夜血氧饱和度低于90%时间比(18.8±16.4),与正常组(0.1±0.5)、轻度组(1.7±5.8)、中度组(2.9±3.8)AHI患者差异均有统计学意义(F=35.40,P<0.001)。10年ASCVD风险评估分析显示,整夜血氧饱和度低于90%时间比、整夜暂停时间占整夜睡眠比与患者10年ASCVD风险相关(OR=1.15,P=0.001;OR=1.09,P=0.013)。结论：整夜血氧饱和度低于90%时间比和整夜暂停时间占整夜睡眠比可作为阻塞性睡眠呼吸暂停患者的整夜病情评估指标,与患者10年ASCVD风险相关。

关键词: 睡眠呼吸暂停综合征, 监测, 便携式, 危险性评估, 心血管疾病

Abstract:

Objective: To explore overnight assessment indicators and cardiovascular disease risk predicators of obstructive sleep apnea using portable sleep monitoring. Methods: A retrospective, clinical case analysis was used to screen 192 outpatients and inpatients from May 2019 to July 2020. Physical measurements, blood pressure, past medical history, and biochemical indicators of the patients were recorded. Data of AHI, lowest oxygen saturation, average oxygen saturation, longest apnea duration, longest hypopnea duration, the ratio of overnight oxygen saturation below 90%, the ratio of total apnea time to sleep time, the ratio of total hypopnea time to sleep time and Epworth sleepiness scale were collected for analysis. According to the criteria, 152 patients were included for ASCVD risk analysis with China-PAR model, PM indexes that influence ASCVD risk were analyzed. Results: One hundred and seventy-nine patients diagnosed with obstructive sleep apnea-hypopnea syndrome. Among PM monitoring indexes, lowest oxygen saturation (OR=0.84, P=0.002) and longest apnea duration (OR=0.96, P=0.017) were negative corrected to AHI, total apnea time to sleep time ratio (OR=1.89, P<0.001), total hypopnea time to sleep time ratio (OR=2.23, P<0.001) were positive corrected to AHI, the others indexes were not statistically corrected to AHI. Statistically significant differences of T90% were found in severe AHI group and the other groups (severe AHI group vs. normal/mild/moderate AHI group:18.8±16.4 vs. 0.1±0.5/1.7±5.8/2.9±3.8, F=35.40, P<0.001). T90% and the ratio of total apnea time to sleep time were associated with 10-year ASCVD risk in obstructive sleep apnea-hypopnea syndrome patients (T90%: OR=1.15, P=0.001; total apnea time to sleep time: OR=1.09, P=0.013). Conclusion: The ratio of overnight oxygen saturation below 90% and total apnea time to test time ratio can be suggested as all-night evaluation indexes and indicator factors for ASCVD risk of obstructive sleep apnea-hypopnea syndrome patients.

Key words: Sleep apnea syndromes, Monitoring, ambulatory, Risk assessment, Cardiovascular diseases

中图分类号:

R563.8

曾文美, 吴苏龙, 刘灼帆, 袁茏, 陈碧琳, 荣艳. 便携式睡眠监测对阻塞性睡眠呼吸暂停低通气患者整夜病情评估及心血管疾病风险因素分析[J]. 结核与肺部疾病杂志, 2025, 6(1): 1-7. doi: 10.19983/j.issn.2096-8493.2024132

Zeng Wenmei, Wu Sulong, Liu Zhuofan, Yuan Long, Chen Bilin, Rong Yan. Analysis of all-night evaluation indexes and predictors of cardiovascular risk in patients with obstructive sleep apnea-hypopnea syndrome[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(1): 1-7. doi: 10.19983/j.issn.2096-8493.2024132

图/表 6

表1

三组患者临床资料分布情况

临床资料	轻度组(45例)	中度组(58例)	重度组(76例)
性别[例(构成比,%)]
男性	34(75.6)	50(86.2)	67(88.2)
女性	11(24.4)	8(13.8)	9(11.8)
中位年龄[岁,M(Q₁,Q₃)]	45(35.8,58.3)	45(36.0,51.0)	48(41.0,55.8)
颈围(cm, $x ˉ$ ±s)
男性	41.0±2.5	40.6±3.7	42.5±2.6
女性	38.5±2.6	35.4±1.7	36.8±2.6
BMI( $x ˉ$ ±s)
男性	26.0±3.2	26.7±3.7	27.5±4.0
女性	26.7±2.9	24.5±2.3	26.9±3.0
AHI( $x ˉ$ ±s)
男性	10.3±2.8	20.4±3.9	48.5±14.8
女性	9.3±2.6	23.4±5.7	48.6±12.3
ESS(分, $x ˉ$ ±s)	4.4±2.3	8.5±2.8	13.7±3.0

表1

表2

各监测指标与AHI相关性分析

指标	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
最低血氧饱和度	―0.173	0.055	10.015	0.002	0.84	0.76~0.94
整夜血氧饱和度低于90%时间比	―0.105	0.059	3.178	0.075	0.90	0.80~1.01
平均血氧饱和度	―0.141	0.113	1.559	0.212	0.87	0.70~1.08
最长暂停时间	―0.040	0.017	5.737	0.017	0.96	0.93~0.99
最长低通气时间	―0.020	0.013	2.471	0.116	0.98	0.96~1.01
整夜阻塞性呼吸暂停时间占睡眠时间比	0.639	0.099	41.350	<0.001	1.89	1.56~2.30
整夜低通气时间占睡眠时间比	0.803	0.129	38.821	<0.001	2.23	1.73~2.87
艾普沃斯嗜睡量表评分	―0.999	0.630	2.514	0.113	0.37	0.11~1.27

表2

表3

表4

动脉粥样硬化性心血管疾病风险评估患者基本信息指标统计

指标	低风险组(75例)	中风险组(47例)	高风险组(30例)
性别[例,构成比(%)]
男性	61(81.3)	42(89.4)	28(93.3)
女性	14(18.7)	5(10.6)	2(6.7)
年龄[岁,M(Q₁,Q₃)]	46(38,57)	47(41,54)	47(40,55)
腰围(cm, $x ˉ$ ±s)	90.4±9.8	93.7±10.7	95.8±10.3
糖尿病[例,发生率(%)]	3(4.0)	8(17.0)	6(20.0)
高血压[例,发生率(%)]	21(28.0)	30(63.8)	23(76.7)
目前吸烟[例,发生率(%)]	20(26.7)	19(40.4)	15(50.0)
心脑血管病家族史[例,发生率(%)]	1(1.3)	3(6.4)	2(6.7)

表4

表5

动脉粥样硬化性心血管疾病风险评估患者睡眠监测指标统计

指标	低风险组(75例)	中风险组(47例)	高风险组(30例)	F值	P值
睡眠呼吸暂停低通气指数(次/h, $x ˉ$ ±s)	18.4±9.9	34.2±12.9	53.8±17.4	87.70	<0.001
最长暂停时间(s, $x ˉ$ ±s)	45.4±17.2	66.4±22.9	81.0±21.1	39.10	<0.001
最长低通气时间(s, $x ˉ$ ±s)	55.8±17.3	59.8±17.7	53.8±18.4	1.23	0.334
整夜暂停时间占睡眠时间比(%, $x ˉ$ ±s)	5.4±4.4	21.3±11.7	41.0±18.1	121.39	<0.001
整夜低通气时间占睡眠时间比(%, $x ˉ$ ±s)	5.8±4.6	4.6±3.5	4.4±5.9	1.42	0.048
整夜暂停及低通气总时间占睡眠时间比(%, $x ˉ$ ±s)	11.1±6.4	25.9±11.6	45.4±15.0	122.80	<0.001
最低血氧饱和度(%, $x ˉ$ ±s)	82.7±6.1	72.4±9.9	63.9±10.0	60.70	0.231
整夜血氧饱和度低于90%时间比( $x ˉ$ ±s)	1.9±2.5	11.1±9.7	28.3±3.3	80.10	<0.001
平均血氧饱和度(%, $x ˉ$ ±s)	94.3±2.3	93.3±2.0	90.0±3.2	25.60	0.327

表5

表6

阻塞性睡眠呼吸暂停低通气综合征患者10年ASCVD风险影响因素分析

分类	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
ASCVD中风险	18.649	16.645	1.255	0.263	125684736.60	―13.97~51.27
ASCVD高风险	22.673	16.717	1.839	0.175	7026684345.00	―10.09~55.44
整夜血氧饱和度低于90%时间比	0.142	0.043	11.053	0.001	1.15	1.06~1.25
平均血氧饱和度	0.165	0.180	0.838	0.360	1.17	0.83~1.68
最低血氧饱和度	―0.019	0.036	0.266	0.606	0.98	0.91~1.05
最长低通气时间	0.011	0.014	0.624	0.429	1.01	0.98~1.04
最长暂停时间	0.009	0.013	0.494	0.482	1.01	0.98~1.04
整夜暂停时间占睡眠时间比	0.083	0.033	6.130	0.013	1.09	1.02~1.16
整夜低通气时间占睡眠时间比	―0.058	0.057	1.024	0.312	0.94	0.84~1.06
AHI分级	0.795	0.449	3.136	0.077	2.22	0.92~5.34

表6

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