SHAO Chuan,FANG Qing,CHEN Yinyu, et al. Clinical phenotyping of obstructive sleep apnea-hypopnea syndrome based on excessive daytime sleepiness[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2021, 51(2): 118-122.
摘要目的：探讨伴有日间过度嗜睡（EDS）的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的临床特征及EDS的危险因素。方法：入选413例经整夜多导睡眠（PSG）监测确诊的OSAHS患者，根据Epworth嗜睡评分（ESS）将患者分为有EDS组（ESS≥11）和无EDS组（ESS≤10），比较2 组的临床特征和PSG结果，用多因素分析探讨EDS的独立危险因素。结果：与无EDS组比，有EDS组患者同时主诉夜间憋醒（51.8% vs.36%）、晨起头痛（25.5% vs. 11%）、记忆力下降（72.3% vs. 54.8%）、生活受影响（50.4% vs. 35.3%）、工作受影响（47.5% vs. 19.5%）和交通受影响（24.8% vs. 9.6%）的比例较高；微觉醒指数（MAI）（50.72±21.20 vs.39.43±19.50）和呼吸暂停低通气指数（AHI）（56.18±22.74 vs. 35.21±23.04）更高，最长呼吸暂停时间[（66.60±29.24）s vs.（ 55.05±25.01）s]更长，夜间最低SpO2[（63.96±16.85）% vs.（ 74.04±12.27）%]和平均SpO2[（91.25±4.55）% vs. （93.92±2.62）%]更低，氧减饱和指数（ODI）（57.89±24.10 vs.36.34±24.12）更高，夜间氧饱和度小于90%的时间（SIT90）（14.5% vs. 4.3%）更长。多因素分析提示，晨起头痛[OR（95%CI）=3.809（1.704～8.514）]、记忆力下降[OR（95%CI）=1.914（1.002～3.654）]、日常工作[OR（95%CI）=3.445（1.772～6.698）]和交通[OR（95%CI）=2.468（1.061～5.738）]受影响与EDS独立相关，MAI[OR（95%CI）=1.030（1.015～1.045）]、AHI[OR（95%CI）=1.043（1.006～1.081）]和SIT90[OR（95%CI ）=1.038（1.018～1.058）]均为EDS的独立危险因素。结论：有EDS的OSAHS患者与无EDS的患者比有更多的合并症状。睡眠片段化、AHI和夜间低氧均为EDS的独立危险因素。
Abstract：Objective: To investigate the clinical characteristics in patients with obstructive sleep apneahypopnea syndrome (OSAHS) and excessive daytime sleepiness (EDS) and the possible risk factors of EDS.Methods: A total of 413 OSAHS patients were assigned to the EDS or the non-EDS group according to the Epworth sleepiness scores. Univariate and multivariate analysis was conducted on clinical features and polysomnographic variables. Results: The incidences of gasping/choking (51.8% vs. 36%), morning headache(25.5% vs. 11%), and memory loss (72.3% vs. 54.8%) were higher in the EDS group. A higher percentage of patients in the EDS group complained life (50.4% vs. 35.3%), work (47.5% vs. 19.5%) and commute (24.8% vs.9.6%) disturbance. The micro-arousal index (MAI) (50.72±21.20 vs. 39.43±19.50), apnea hypopnea index(AHI) (56.18±22.74 vs. 35.21±23.04), the longest time of apnea [(66.60±29.24)s vs. (55.05±25.01)s], oxygen desaturation index (ODI) (57.89±24.10 vs. 36.34±24.12) and the saturation impair time below 90% (SIT90)(14.5% vs. 4.3%) were higher or longer in the EDS group. The nadir [(63.96±16.85)% vs.(74.04±12.27)%] and mean nocturnal SpO2 [(91.25±4.55)% vs. (93.92±2.62)%] was lower in the EDS group. Multivariate analysis showed morning headache [OR(95%CI)=3.809(1.704-8.514)], memory loss [OR(95%CI)=1.914(1.002-3.654)],work [OR(95%CI)=3.445(1.772-6.698)] and commute disturbances [OR(95%CI)=2.468(1.061-5.738)] were independently associated with EDS, and the MAI [OR(95%CI)=1.030(1.015-1.045)], AHI [OR(95%CI)=1.043(1.006-1.081)] and SIT90 [OR(95%CI)=1.038(1.018-1.058)] were independent risk factors of EDS.Conclusion: OSAHS patients with EDS have more comorbid symptoms than those without EDS. Sleep fragmentation, AHI and nocturnal hypoxia are independent risk factors for EDS.
