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Article(id=1240972420471902379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311525, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1701014400000, receivedDateStr=2023-11-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800481193, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800481193, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800481193, creator=13701087609, updateTime=1773800481193, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1719, endPage=1723, ext={EN=ArticleExt(id=1240972420757115059, articleId=1240972420471902379, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on duration distribution of respiratory events and prediction of influencing factors of nocturnal minimum oxygen saturation in patients with obstructive sleep apnea, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To describe the distribution characteristics of the duration of respiratory events in patients with obstructive sleep apnea (OSA) and analyze the predictive factors of nocturnal minimum blood oxygen saturation.

Methods

A total of 265 OSA patients who underwent polysomnography (PSG) in the Sleep Medicine Center of the West China Fourth Hospital of Sichuan University from January to December 2022 were divided into mild, moderate, and severe groups according to their Apnea Hyponea Index (AHI) values. The differences of basic information and sleep parameters dominated by respiratory events were described. The correlation factors of nocturnal lowest oxygen saturation were selected, and the factors with r > 0.3 were included in the multiple linear regression model.

Results

With the aggravation of OSA, the proportion of male, smoking and drinking increased, neck circumference, apnea index, longest apnea time, snoring index, and maximum systolic blood pressure increased (P < 0.05). The lowest oxygen saturation at night was correlated with sex, age, BMI, apnea index, longest apnea time, and average apnea time. Multiple linear regression results showed that the longest apnea time, apnea index, BMI, and the highest systolic blood pressure were negatively correlated with the lowest nocturnal oxygen saturation (P < 0.05). The longest apnea time was the strongest predictor of the lowest nocturnal oxygen saturation (standardized β=-0.516, P < 0.05, 95%CI: -0.579 to-0.453).

Conclusion

The longest apnea time plays an important role in evaluating the severity of OSA and predicting the lowest blood oxygen saturation at night.

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目的

描述阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）患者呼吸事件持续时间的分布特征，分析夜间最低血氧饱和度的预测因素。

方法

选取2022年1—12月在四川大学华西第四医院睡眠医学中心行多导睡眠监测的265名阻塞性睡眠呼吸暂停患者为研究对象，按呼吸暂停低通气指数值分为轻、中、重三组，描述各组基本信息和以呼吸事件为主的睡眠参数的差异，选取夜间最低血氧饱和度的关联性因素，将r>0.3的因素纳入多重线性回归模型。

结果

随着OSA病情加重，男性、吸烟、饮酒人数占比上升（P<0.05），颈围、呼吸暂停指数、最长呼吸暂停时间、打鼾指数、最高收缩压增加（P<0.05）。夜间最低血氧饱和度与性别、年龄、BMI、呼吸暂停指数、最长呼吸暂停时间、平均呼吸暂停时间等指标相关（P<0.05）。多重线性回归结果显示，最长呼吸暂停时间、呼吸暂停指数、BMI、最高收缩压与夜间最低血氧饱和度呈负相关（P<0.05），最长呼吸暂停时间对夜间最低血氧饱和度的预测意义最强（标化β=-0.516，P<0.05，95%CI：-0.579～-0.453）。

结论

最长呼吸暂停时间在评估OSA严重程度和预测夜间最低血氧饱和度时能够发挥重要作用。

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张晓晴，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=qe9TwrKkH2CNV9e7wThRgg==, magXml=BWcHCyK8yZLVyCv4SxHfGw==, pdfUrl=null, pdf=JaXR6gS0OrITbTUhH66ByA==, pdfFileSize=542342, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=SONwq3kwFPcbmwdc71n8sA==, mapNumber=null, authorCompany=null, fund=null, authors=

胡雨阳（1996—），男，硕士在读，研究方向：劳动卫生与环境卫生学

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胡雨阳（1996—），男，硕士在读，研究方向：劳动卫生与环境卫生学

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Current Molecular Medicine, 2020, 20(3): 231-239., articleTitle=Change in quality of Life of OSAHS patients with minimally invasive surgery or CPAP therapy: a 2-year retrospective, single-center parallel-group study, refAbstract=null), Reference(id=1240986279391842771, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, doi=null, pmid=null, pmcid=null, year=2021, volume=25, issue=2, pageStart=829, pageEnd=834, url=null, language=null, rfNumber=[20], rfOrder=23, authorNames=Zhang XQ, Liu LJ, Li XY, journalName=Sleep and Breathing, refType=null, unstructuredReference=Zhang XQ, Liu LJ, Li XY, et al. Effect of minimally invasive surgery on the sleep quality and work ability of patients with obstructive sleep apnea-hypopnea syndrome[J]. Sleep and Breathing,2021, 25(2): 829-834., articleTitle=Effect of minimally invasive surgery on the sleep quality and work ability of patients with obstructive sleep apnea-hypopnea syndrome, refAbstract=null), Reference(id=1240986279542837718, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, doi=null, pmid=null, pmcid=null, year=2017, volume=21, issue=4, pageStart=829, pageEnd=835, url=null, language=null, rfNumber=[21], rfOrder=24, authorNames=Kulkas A, Duce B, Leppnen T, journalName=Schlaf &Atmung, refType=null, unstructuredReference=Kulkas A, Duce B, Leppnen T, et al. Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea[J]. Schlaf &Atmung, 2017, 21(4): 829-835., articleTitle=Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea, refAbstract=null)], funds=[Fund(id=1240986273897304433, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, awardId=2021YFH0165, language=CN, fundingSource=四川省科技计划项目(2021YFH0165), fundOrder=null, country=null), Fund(id=1240986274010550644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, awardId=202112 20SK, language=CN, fundingSource=市厅级项目(202112 20SK), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240986264858578969, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, xref=null, ext=[AuthorCompanyExt(id=1240986264883744799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, companyId=1240986264858578969, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University / Department of Otorhinolaryngology, West China Fourth Hospital,Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240986264887939103, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, companyId=1240986264858578969, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041)])], figs=[ArticleFig(id=1240986271426859325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=EN, label=Table 1, caption=

Baseline information of patients with OSA

, figureFileSmall=null, figureFileBig=null, tableContent=
类别频数(%)/（）
性别
男243(90.3)
女26(9.7)
年龄（岁）40.7±10.2
BMI（kg/m2）26.9±4.1
颈围（cm）39.2±3.6
学历
初中及以下18(6.7)
高中31(11.5)
专科61(22.7)
本科119(44.2)
研究生及以上40(14.9)
民族
汉族264(98.1)
其他5(1.9)
吸烟
是90(33.5)
否179(66.5)
饮酒
是144(42.8)
否125(57.2)
OSA分级
轻度51(19.0)
中度48(17.8)
重度170(63.2)
), ArticleFig(id=1240986271615603007, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=CN, label=表1, caption=

OSA患者基本信息

, figureFileSmall=null, figureFileBig=null, tableContent=
类别频数(%)/（）
性别
男243(90.3)
女26(9.7)
年龄（岁）40.7±10.2
BMI（kg/m2）26.9±4.1
颈围（cm）39.2±3.6
学历
初中及以下18(6.7)
高中31(11.5)
专科61(22.7)
本科119(44.2)
研究生及以上40(14.9)
民族
汉族264(98.1)
其他5(1.9)
吸烟
是90(33.5)
否179(66.5)
饮酒
是144(42.8)
否125(57.2)
OSA分级
轻度51(19.0)
中度48(17.8)
重度170(63.2)
), ArticleFig(id=1240986271871455555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=EN, label=Table 2, caption=

Comparison of baseline information and respiratory events in different OSA groups ［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标轻度（n=51）中度（n=48）重度（n=170）F/χ2值P值
性别（男）35(68.6)43(89.6)165(97.1)36.3580.000a
吸烟史6(11.8)16(33.3)70(41.2)15.10.001a
饮酒史19(37.2)26(54.2)99(58.2)6.9510.031a
年龄(岁）35.7±10.440.5±10.242.2±9.78.4540.000
BMI（kg/m2）24.0±4.224,9±2.326.9±4.135.7030.000
颈围（cm）36.0±3.637.9±3.040.5±3.045.1640.000b
AI（次/h）4.4±2.613.4±5.455.0±20.8241.1110.000b
LAD（s）36.6±10.646.8±13.970.1±23.565.7130.000b
MAD（s）21.3±4.322.5±3.627.4±7.025.5800.000
HI（次/h）4.9±2.47.7±3.96.8±3.44.1470.017
LHD（s）39.33±7.240.5±7.039.5±11.00.2020.817
MHD（s）23.9±3.423.4±2.622.0±4.55.4500.005
SAI（次/h）34.9±11.537.5±13.757.2±17.455.6160.000
SP（%）55.1±23.354.5±21.557.7±24.10.4450.642
SI（次/h）90.1±51.6157.3±93.8272.8±108.879.3970.000b
HHR（次/min）97.9±18.7101.7±11.5107.5±13.210.3480.000
HSBP（mm Hg）142.2±34.0162.7±50.3191.4±37.534.0910.000b
HDBP（mm Hg）83.7±17.688.8±11.294.1±13.912.9410.000
), ArticleFig(id=1240986272576098635, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=CN, label=表2, caption=

OSA患者各组基本信息及呼吸事件分布情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标轻度（n=51）中度（n=48）重度（n=170）F/χ2值P值
性别（男）35(68.6)43(89.6)165(97.1)36.3580.000a
吸烟史6(11.8)16(33.3)70(41.2)15.10.001a
饮酒史19(37.2)26(54.2)99(58.2)6.9510.031a
年龄(岁）35.7±10.440.5±10.242.2±9.78.4540.000
BMI（kg/m2）24.0±4.224,9±2.326.9±4.135.7030.000
颈围（cm）36.0±3.637.9±3.040.5±3.045.1640.000b
AI（次/h）4.4±2.613.4±5.455.0±20.8241.1110.000b
LAD（s）36.6±10.646.8±13.970.1±23.565.7130.000b
MAD（s）21.3±4.322.5±3.627.4±7.025.5800.000
HI（次/h）4.9±2.47.7±3.96.8±3.44.1470.017
LHD（s）39.33±7.240.5±7.039.5±11.00.2020.817
MHD（s）23.9±3.423.4±2.622.0±4.55.4500.005
SAI（次/h）34.9±11.537.5±13.757.2±17.455.6160.000
SP（%）55.1±23.354.5±21.557.7±24.10.4450.642
SI（次/h）90.1±51.6157.3±93.8272.8±108.879.3970.000b
HHR（次/min）97.9±18.7101.7±11.5107.5±13.210.3480.000
HSBP（mm Hg）142.2±34.0162.7±50.3191.4±37.534.0910.000b
HDBP（mm Hg）83.7±17.688.8±11.294.1±13.912.9410.000
), ArticleFig(id=1240986273066832210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=EN, label=Table 3, caption=

Single-factor correlation analysis of the lowest saturation of pulse oxygen

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指标rP值
性别0.2210.000
年龄（岁）-0.1520.006
吸烟史-0.2570.000
饮酒史-0.1180.027
BMI（kg/m2）-0.5240.000
AI（次/h）-0.6990.000
LAD（s）-0.7630.000
MAD（s）-0.5380.000
HI（次/h）0.0910.068
LHD（s）-0.0290.319
MHD（s）0.1290.017
SAI（次/h）-0.4530.000
SP（%）-0.0560.179
SI（次/h）-0.5270.000
HHR（次/min）-0.2210.000
HSBP（mm Hg）-0.5630.000
HDBP（mm Hg）-0.2920.000
), ArticleFig(id=1240986273276547415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=CN, label=表3, caption=

最低血氧饱和度的单因素相关分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标rP值
性别0.2210.000
年龄（岁）-0.1520.006
吸烟史-0.2570.000
饮酒史-0.1180.027
BMI（kg/m2）-0.5240.000
AI（次/h）-0.6990.000
LAD（s）-0.7630.000
MAD（s）-0.5380.000
HI（次/h）0.0910.068
LHD（s）-0.0290.319
MHD（s）0.1290.017
SAI（次/h）-0.4530.000
SP（%）-0.0560.179
SI（次/h）-0.5270.000
HHR（次/min）-0.2210.000
HSBP（mm Hg）-0.5630.000
HDBP（mm Hg）-0.2920.000
), ArticleFig(id=1240986273373016413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=EN, label=Table 4, caption=

Multiple linear regression of the lowest saturation of pulse oxygen

, figureFileSmall=null, figureFileBig=null, tableContent=
指标未标化B 标化βt值P值标化β的95%CI
下限上限
BMI（kg/m2）-0.5160.117-0.191-4.4260.000-0.4200.038
AI（次/h）-0.1040.025-0.264-4.1270.000-0.313-0.215
LAD（s）-0.2320.032-0.516-7.1480.000-0.579-0.453
MAD（s）-0.0770.113-0.046-0.6810.496-0.2670.175
HI（次/h）-0.1580.099-0.074-1.6020.110-0.2680.120
LHD（s）-0.0770.058-0.068-1.3320.184-0.1820.046
MHD（s）0.1790.1460.0671.2290.220-0.2190.353
SAI（次/h）0.0410.0270.0711.5320.1270.0180.124
SI（次/h）-0.0020.004-0.019-0.4010.689-0.027-0.011
HSBP（mm Hg）-0.0270.010-0.110-2.6220.009-0.130-0.090
), ArticleFig(id=1240986273503039844, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420471902379, language=CN, label=表4, caption=

最低血氧饱和度的多重线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标未标化B 标化βt值P值标化β的95%CI
下限上限
BMI（kg/m2）-0.5160.117-0.191-4.4260.000-0.4200.038
AI（次/h）-0.1040.025-0.264-4.1270.000-0.313-0.215
LAD（s）-0.2320.032-0.516-7.1480.000-0.579-0.453
MAD（s）-0.0770.113-0.046-0.6810.496-0.2670.175
HI（次/h）-0.1580.099-0.074-1.6020.110-0.2680.120
LHD（s）-0.0770.058-0.068-1.3320.184-0.1820.046
MHD（s）0.1790.1460.0671.2290.220-0.2190.353
SAI（次/h）0.0410.0270.0711.5320.1270.0180.124
SI（次/h）-0.0020.004-0.019-0.4010.689-0.027-0.011
HSBP（mm Hg）-0.0270.010-0.110-2.6220.009-0.130-0.090
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阻塞性睡眠呼吸暂停患者呼吸事件持续时间分布及夜间最低血氧饱和度影响因素预测研究
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胡雨阳 , 张晓晴 , 李婉姝 , 杨洋 , 欧小华 , 王晓梅
现代预防医学 | 临床与预防 2024,51(9): 1719-1723
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现代预防医学 | 临床与预防 2024, 51(9): 1719-1723
阻塞性睡眠呼吸暂停患者呼吸事件持续时间分布及夜间最低血氧饱和度影响因素预测研究
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胡雨阳, 张晓晴 , 李婉姝, 杨洋, 欧小华, 王晓梅
作者信息
  • 四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041

    • 胡雨阳（1996—），男，硕士在读，研究方向：劳动卫生与环境卫生学

通讯作者:

张晓晴，E-mail:
Study on duration distribution of respiratory events and prediction of influencing factors of nocturnal minimum oxygen saturation in patients with obstructive sleep apnea
Yu-yang HU, Xiao-qing ZHANG , Wan-shu LI, Yang YANG, Xiao-hua OU, Xiao-mei WANG
Affiliations
  • West China School of Public Health, Sichuan University / Department of Otorhinolaryngology, West China Fourth Hospital,Chengdu, Sichuan 610041, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202311525
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摘要
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目的

描述阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）患者呼吸事件持续时间的分布特征，分析夜间最低血氧饱和度的预测因素。

方法

选取2022年1—12月在四川大学华西第四医院睡眠医学中心行多导睡眠监测的265名阻塞性睡眠呼吸暂停患者为研究对象，按呼吸暂停低通气指数值分为轻、中、重三组，描述各组基本信息和以呼吸事件为主的睡眠参数的差异，选取夜间最低血氧饱和度的关联性因素，将r>0.3的因素纳入多重线性回归模型。

结果

随着OSA病情加重，男性、吸烟、饮酒人数占比上升（P<0.05），颈围、呼吸暂停指数、最长呼吸暂停时间、打鼾指数、最高收缩压增加（P<0.05）。夜间最低血氧饱和度与性别、年龄、BMI、呼吸暂停指数、最长呼吸暂停时间、平均呼吸暂停时间等指标相关（P<0.05）。多重线性回归结果显示，最长呼吸暂停时间、呼吸暂停指数、BMI、最高收缩压与夜间最低血氧饱和度呈负相关（P<0.05），最长呼吸暂停时间对夜间最低血氧饱和度的预测意义最强（标化β=-0.516，P<0.05，95%CI：-0.579～-0.453）。

结论

最长呼吸暂停时间在评估OSA严重程度和预测夜间最低血氧饱和度时能够发挥重要作用。

阻塞性睡眠呼吸暂停  /  呼吸暂停  /  低通气  /  最低血氧饱和度
Objective

To describe the distribution characteristics of the duration of respiratory events in patients with obstructive sleep apnea (OSA) and analyze the predictive factors of nocturnal minimum blood oxygen saturation.

Methods

A total of 265 OSA patients who underwent polysomnography (PSG) in the Sleep Medicine Center of the West China Fourth Hospital of Sichuan University from January to December 2022 were divided into mild, moderate, and severe groups according to their Apnea Hyponea Index (AHI) values. The differences of basic information and sleep parameters dominated by respiratory events were described. The correlation factors of nocturnal lowest oxygen saturation were selected, and the factors with r > 0.3 were included in the multiple linear regression model.

Results

With the aggravation of OSA, the proportion of male, smoking and drinking increased, neck circumference, apnea index, longest apnea time, snoring index, and maximum systolic blood pressure increased (P < 0.05). The lowest oxygen saturation at night was correlated with sex, age, BMI, apnea index, longest apnea time, and average apnea time. Multiple linear regression results showed that the longest apnea time, apnea index, BMI, and the highest systolic blood pressure were negatively correlated with the lowest nocturnal oxygen saturation (P < 0.05). The longest apnea time was the strongest predictor of the lowest nocturnal oxygen saturation (standardized β=-0.516, P < 0.05, 95%CI: -0.579 to-0.453).

Conclusion

The longest apnea time plays an important role in evaluating the severity of OSA and predicting the lowest blood oxygen saturation at night.

Obstructive sleep apnea  /  Apnea  /  hypopnea  /  Minimum oxygen saturationgen
胡雨阳, 张晓晴, 李婉姝, 杨洋, 欧小华, 王晓梅. 阻塞性睡眠呼吸暂停患者呼吸事件持续时间分布及夜间最低血氧饱和度影响因素预测研究. 现代预防医学, 2024 , 51 (9) : 1719 -1723 . DOI: 10.20043/j.cnki.MPM.202311525
Yu-yang HU, Xiao-qing ZHANG, Wan-shu LI, Yang YANG, Xiao-hua OU, Xiao-mei WANG. Study on duration distribution of respiratory events and prediction of influencing factors of nocturnal minimum oxygen saturation in patients with obstructive sleep apnea[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1719 -1723 . DOI: 10.20043/j.cnki.MPM.202311525
正文
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阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)是一种慢性疾病，其特征是睡眠期间反复出现呼吸暂停和低通气事件，常引起夜间低氧、高碳酸血症及睡眠结构碎片化，长期存在会导致全身多器官和系统的损害[1]。呼吸暂停低通气指数（apnea-hypopnea index, AHI）于20世纪80年代一经提出便迅速成为了OSA的诊断标准。呼吸事件引发的间歇性低氧血症会导致一系列的代谢性疾病，既往研究的结果显示，AHI对于OSA患者的血脂、血压、尿酸有较好的预测作用[2-3]。AHI在睡眠医学界已经使用了几十年，它对了解这种慢性疾病的严重程度的贡献无疑是巨大的。AHI计算和解释简单，为所有睡眠临床医生和研究人员所熟知，为临床调查的评估和讨论提供了一种共同的语言[4]。
然而AHI却平等地考虑了呼吸暂停与低通气对于OSA分级的贡献，忽略了呼吸事件本身的存在形态和持续时间，显然呼吸暂停与低通气会引起不等的生物学效应，持续时间的长短所带来的应激反应也不同——相同持续时间的呼吸暂停导致的低氧血症较低通气更加严重，单一呼吸事件的持续也会增加低氧血症的严重程度。本研究通过观察并分析OSA患者呼吸事件持续时间的分布特征及差异，探索夜间最低血氧水平的预测因素，寻求呼吸事件持续时间在优化OSA防治及诊断中的实际意义，从医防结合的角度出发，为OSA诊治及预后提供参考依据。
1　资料与方法
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1.1　对象
本研究选取2022年1—12月于四川大学华西第四医院睡眠医学中心因“夜间打鼾憋气”就诊，经多导睡眠监测（polysomnography, PSG）确诊为OSA且满足纳入与排除标准的患者共269名。研究获得四川大学华西第四医院医学伦理委员会批准（批件号：HXSY-EC-2021022），所有调查对象均签署知情同意书。
纳入标准：（1）基线资料完整；（2）整夜执行PSG；（3）年龄≥18岁。
排除标准：（1）合并严重心脏、肺部疾病及肝肾功能不全者；（2）近期使用无创呼吸机治疗；（3）中枢性事件≥50%；（4）睡眠时间<7h。
1.2　方法
1.2.1　PSG检查
SOMNOscreenTMplus PSG+型号多导睡眠监测仪为此次研究的监测设备。患者入院各项准备事宜完成后，为患者佩戴该设备，22:30统一关灯，关灯后禁止患者看电视、使用电子设备，次日早晨7:00结束监测。
根据《成人阻塞性睡眠呼吸暂停多学科诊疗指南》[5]对OSA进行分级：正常（AHI<5次/h）、轻度（5次/h≤AHI<15次/h）、中度（15次/h≤AHI<30次/h）和重度（AHI≥30次/h）。呼吸暂停被定义为气流减少≥90%，持续时间≥10s；低通气被定义为气流减少≥30%伴4%的血氧下降，持续时间≥10s或气流减少≥50%伴3%的血氧下降，持续时间≥10s[6]。
1.2.2　观察指标
导出PSG数据，主要观察的参数为AHI、呼吸暂停指数（apnea index, AI）、最长呼吸暂停时间（longest apnea duration, LAD）、平均呼吸暂停时间（mean apnea duration, MAD）、低通气指数（hypopnea index, HI）、最长低通气时间（longest hypopnea duration, LHD）、平均低通气时间（mean hypopnea duration, MHD）、睡眠觉醒指数（sleep awakening index, SAI）、仰卧睡眠占比（supine proportion, SP）、打鼾指数（snore index, SI）、最高心率（highest heart rate, HHR）、最高收缩压（highest systolic blood pressure, HSBP）、最高舒张压（highest diastolic blood pressure, HDBP）。
1.3　统计学方法
选用SPSS 26.0统计软件对数据进行处理。计量资料采用（）表示，组间比较采用方差分析，后续两两比较采用LSD方法，计数资料用百分率表示，组间比较采用χ2检验；夜间最低血氧水平影响因素研究先采用Pearson单因素相关分析，再将显著性结果中|r|>0.3的因素纳入多重线性回归模型。检验水准α=0.05。
2　结果
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2.1　OSA患者基本信息
共纳入269名通过纳入和排除标准的OSA患者，平均年龄为（40.7±10.2）岁；男性居多，占90.3%；以汉族为主，占98.1%，其他民族包括蒙古族2人，藏族1人，回族1人，彝族1人；按OSA诊断标准分级：轻度51人，中度48人，重度170人。其他信息见表1。
2.2　OSA患者各组基本信息及呼吸事件分布情况比较
LHD和SP占比的组间差异不具有统计学意义（P>0.05），其余指标在研究对象组间的差异均具有统计学意义（P<0.05）。男性、吸烟、饮酒者的占比在组间存在上升趋势（P<0.05），颈围、AI、LAD、SI、HSBP在组间呈上升趋势（P<0.05）。见表2。
2.3　最低血氧饱和度的单因素相关分析
以最低血氧饱和度为因变量，表2中各指标为自变量，经Pearson单因素相关性分析发现，最低血氧饱和度与性别、吸烟史、饮酒史、年龄、BMI等15个因素相关（P<0.05），与HI、LHD、SP不相关（P>0.05）。见表3。
2.4　最低血氧饱和度的多重线性回归分析
将表3中|r|>0.3的指标纳入多重线性回归模型，并考虑低通气指标对OSA诊断的贡献，在调整了年龄、性别的影响后，结果显示，对最低血氧饱和度具有预测意义的指标有AI、LAD、HSBP（P<0.05）。VIF不存在大于10的指标，模型复相关系数r=0.857，决定系数R2=0.734。见表4。
3　讨论
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关于OSA呼吸事件持续时间的研究较少，但几乎所有关于OSA研究中都能见到AHI的身影，这与AHI在OSA的诊断中起决定作用有较大关系。依靠AHI来评估OSA的严重程度是当今睡眠医学界的共识，但是呼吸事件持续时间的重要价值也不应该被忽略。根据AHI的定义，假设总睡眠时间相近，短呼吸事件多的患者会有更大的AHI值，长呼吸事件多的患者AHI值较小，这就会引出一个问题：实际上谁的病情更严重？是频繁的短呼吸事件的危害更大，还是更长的呼吸事件持续时间导致的结果更严重？在AHI值>30后，患者属于同一OSA严重程度组，但呼吸暂停和低通气事件的分布和持续时间可能完全不同，因此，这两类OSA患者的临床严重程度和健康后果可能存在显著差异[7-8]。并且大部分的患者在接受诊断和治疗前都已患有OSA多年，因此在诊断OSA时患者健康恶化程度会有所不同，这不仅因为呼吸事件在数量上有不同，还取决于呼吸事件持续时间上的差异。
值得关注的是，近年来有关呼吸事件持续时间的大型研究在慢慢变多，这提示临床医生和科研人员也在逐渐重视这一类参数[9]。一项大型的多民族队列研究结果显示，呼吸事件平均持续时间因人群而异，较短的呼吸事件更多地发生在女性、年轻、肥胖和黑皮肤的人群中，而较长的事件更多地发生在亚裔人群身上[10]。此外，呼吸事件持续时间可能是优化OSA表型的有用参数，因为它能够提供描述OSA主要病理生理特征的数据形式[11-12]。
关于利用呼吸事件持续时间来优化OSA诊断的研究，研究人员早有涉猎，Muraja-Murro等人[8]在2012年就提出了一个用于优化评估OSA严重程度的新参数，总呼吸暂停——低通气持续时间的百分比(total apnea-hypopnea duration%, TAHD%)，并基于此提出了一个综合指标（TAHD%*平均去饱和深度）。在此基础上，该团队2013年又引入了一个新的参数，阻塞严重程度——呼吸事件持续时间和相关去饱和面积的乘积之和[13]，相较于AHI，新的参数都捕捉到了之前未被观察到的信息——呼吸事件的持续时间占比以及对应心脑血管事件的严重程度。
大部分关于呼吸事件持续时间的研究都会提示，长呼吸事件比短呼吸事件带来的健康危害更大[14-17]。2019年Bulter[18]在一项队列研究中分析了呼吸事件持续时间与死亡风险之间的关系，但最终结果却与上述发现完全不同：呼吸事件持续时间最短的患者(前1/4)中，死亡率比事件持续时间最长的患者(后1/4)高20%，在调整了AHI、高血压、糖尿病和心脑血管疾病之后，结果甚至更强，提示了短呼吸事件对全因死亡率有着更加显著的危险比。他们推测，长呼吸事件和短呼吸事件的OSA可能各自代表着不同的表型，两者均有可能导致死亡风险的增加，唯一的区别可能在于介导的生理病理途径不同。
综上所述，即便是轻、中度的OSA患者也应该注意防范风险，对于夜间出现的张口呼吸、憋气现象应当及早地引起重视，积极地参与到“早发现、早诊断、早治疗”环节中去。对于明确诊断的OSA患者，及时选择持续气道正压通气(continuous postive airway pressure, CPAP)治疗将会有效缓解症状，改善生活质量[19]，针对上气道阻塞明显、CPAP不依从及其他保守治疗效果欠佳的患者，微创手术通常是一种比较好的治疗手段[20]。
本研究中，AI、LAD在LSD两两比较中均有统计学意义，这表明基于AHI的OSA分组中上述指标会随着OSA病情加重而上升。夜间最低血氧饱和度的单因素分析中，低通气相关指标显示弱相关或不相关，但由于低通气是OSA夜间呼吸事件的表现形式之一，因此我们仍然选择将其纳入到了多因素回归模型，结果显示，LAD对夜间最低血氧饱和度具有较强的预测意义。以上研究结果提示在关注OSA诊治及预后的过程中，最长呼吸暂停持续时间能提供足够宝贵的信息。
此次研究并未将AHI作为研究因素纳入单因素分析和多重线性回归模型，目的在于拆分和量化呼吸暂停和低通气事件的形态和持续时间对研究结局的影响，显然呼吸暂停有关指标相较于低通气获得了更多有意义的结果，LAD对于最低血氧饱和度的预测意义最强，这与Antti Kulkas等人[21]的研究结果相类似，提示我们呼吸暂停有关指标在评估OSA严重程度和预测长期心血管疾病风险时能够发挥更大的作用。
因此，呼吸事件持续时间包含着一些AHI未能涵盖的信息，这对于优化OSA疾病的防治和补充AHI诊断均有着积极意义。本研究存在一定的局限性。一是，研究为现况研究，不能得出有论证强度的因果结论；二是，样本量不够大，导致女性患者的占比较低。未来在条件成熟的情况下，可以充实样本量，并在前瞻性队列研究中论证上述研究成果。
基金
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  • 四川省科技计划项目(2021YFH0165)
  • 市厅级项目(202112 20SK)
文献
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202311525
  • 接收时间：2023-11-27
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-11-27
基金
四川省科技计划项目(2021YFH0165)
市厅级项目(202112 20SK)
作者信息
    四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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光柄菇属 Pluteus 5 2.39
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