阻塞性睡眠呼吸暂停低通气综合征合并超重或肥胖的临床特征及影响因素研究

Clinical features of obstructive sleep apnea-hypopnea syndrome with overweight or obesity and related influencing factors

摘要:

目的 比较有无超重或肥胖的阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）患者的临床特征和睡眠结构差异，并分析其影响因素。方法 回顾性分析2020年1月至2021年4月在重庆医科大学附属第一医院就诊的458例OSAHS患者临床资料和多导睡眠监测（polysomnography，PSG）结果，根据体质指数（body mass index，BMI）分为单纯OSAHS组和OSAHS合并超重或肥胖组，单纯OSAHS组91例（19.9%），OSAHS合并超重或肥胖组367例（80.1%）。比较两组患者的临床资料和PSG结果，采用单因素分析和回归分析超重或肥胖患者发生OSAHS的影响因素。结果 两组患者在颈围、腰围、OSAHS严重程度、日间嗜睡评分、高血压史、2型糖尿病史、呼吸暂停低通气指数（apnea hypopnea index，AHI）、微觉醒指数、夜间平均氧饱和度（mean oxygen saturation，MSaO₂）和夜间最低氧饱和度（lowest oxygen saturation，LSaO₂）比较，差异有统计学意义（P<0.05）；OSAHS合并超重或肥胖患者的多因素回归分析结果显示BMI（t=2.639，P=0.009）、家族打鼾史（t=-2.521，P=0.001 2）、微觉醒指数（t=12.813，P=0.000）和LSaO₂（t=-7.407，P=0.000）是主要影响因素。结论 有无超重或肥胖的OSAHS患者在临床特征和睡眠结构间具有差异性。BMI升高、有家族打鼾史、微觉醒指数增加及夜间LSaO₂降低是超重或肥胖患者合并OSAHS的独立危险因素。

Abstract:

Objective To investigate the differences in clinical features and sleep structure between patients with obstructive sleep apnea-hypopnea syndrome（OSAHS） with or without overweight/obesity，as well as related influencing factors.Methods A retrospective analysis was performed for the clinical data and polysomnography（PSG） results of 458 OSAHS patients who attended The First Affiliated Hospital of Chongqing Medical University from January 2020 to April 2021，and according to body mass index（BMI），they were divided into OSAHS group and OSAHS+overweight/obesity group. For all 458 patients，there were 91 patients（19.9%） in the OSAHS group and 367 patients（80.1%） in the OSAHS+overweight/obesity group. Clinical data and PSG results were compared between the two groups，and univariate analysis and regression analyses were used to explore the influencing factors for OSAHS in patients with overweight or obesity.Results There were significant differences between the two groups in neck circumference，waist circumference，OSAHS severity，daytime sleepiness score，history of hypertension，history of type 2 diabetes mellitus，apnea hypopnea index，microarousal index，mean oxygen saturation（MSaO₂） at night，and lowest oxygen saturation（LSaO₂） at night（all P<0.05）. The multivariate regression analysis showed that BMI（t=2.639，P=0.009），the family history of snoring（t=-2.521，P=0.0012），microarousal index（t=12.813，P=0.000），and LSaO₂（t=-7.407，P=0.000） were the main influencing factors for OSAHS in patients with overweight or obesity.Conclusion There are differences in clinical features and sleep structure between the OSAHS patients with or without overweight/obesity，and elevated BMI，the family history of snoring，an increase in microarousal index，and a reduction in LSaO₂ are independent risk factors for OSAHS in patients with overweight or obesity.