阻塞性睡眠呼吸暂停患者中 NREM-AHI 大于 REM-AHI 与 REM-AHI 大于 NREM-AHI：临床和多导睡眠图特征。

NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea: clinical and polysomnographic features.

机构信息

Department of Neurology, Fourth Military Medical University, Xi'an, Shaanxi Province, China.

出版信息

Sleep Breath. 2011 Sep;15(3):463-70. doi: 10.1007/s11325-010-0358-z. Epub 2010 May 6.

DOI:10.1007/s11325-010-0358-z

PMID:20443068

Abstract

PURPOSE

Previous studies show a high prevalence of obstructive sleep apnea (OSA) patients with a higher non-rapid eye movement (NREM) apnea-hypopnea index (AHI) (NREM-AHI) than rapid eye movement (REM) AHI (REM-AHI). However, the clinical significance of this phenomenon in patients with OSA is unknown. This study aimed to investigate whether there were significant differences in clinical and polysomnographic features between the NREM-AHI > REM-AHI group and the REM-AHI > NREM-AHI group and to determine whether NREM-AHI > REM-AHI or REM-AHI > NREM-AHI is a specific clinical entity.

METHODS

One hundred forty-two patients with OSA, including 114 males and 28 females, were assessed for specific sleep-related complaints using a semistructured clinical questionnaire, for daytime sleepiness using the Epworth Sleepiness Scale (ESS), for depression using the Beck Depression Inventory (BDI), and for health-related quality of life using the Medical Outcomes Study Short-Form 36 Health Survey questionnaire (SF-36). Anthropometric, clinical, and polysomnographic characteristics were examined between patients with NREM-AHI > REM-AHI and those with REM-AHI > NREM-AHI.

RESULTS

A higher NREM-AHI than REM-AHI was found in 54.9% of the 142 patients with OSA. Overall, males predominated in each group, and there were no significant differences in age, body mass index, medical history, and drug intake between the NREM-AHI > REM-AHI group and the REM-AHI > NREM-AHI group. A high occurrence of NREM-AHI > REM-AHI (94.9%) or REM-AHI > NREM-AHI (90.6%) was found in moderate-to-severe cases each group. Although several indexes of OSA were worse in the NREM-AHI > REM-AHI group than in the REM-AHI > NREM-AHI group, no significant differences in specific sleep-related complaints, ESS score, BDI score, the incidence of daytime sleepiness or depression, and scores of sub-dimensions and the total score on SF-36 were present between the two groups. As compared separately, no significant differences in clinical features were observed in the clinical data for males and females between the two groups.

CONCLUSIONS

Our results show that either NREM-AHI > REM-AHI or REM-AHI > NREM-AHI is more common in moderate-to-severe OSA cases, and there are no significant differences in clinical features between the NREM-AHI > REM-AHI group and the REM-AHI > NREM-AHI group. These findings may suggest that either NREM-AHI > REM-AHI or REM-AHI > NREM-AHI should be considered as a part of the spectrum of OSA, rather than a specific clinical entity.

摘要

目的

先前的研究表明，阻塞性睡眠呼吸暂停（OSA）患者中，非快速眼动（NREM）呼吸暂停-低通气指数（AHI）（NREM-AHI）高于快速眼动（REM）AHI（REM-AHI）的比例较高。然而，这种现象在 OSA 患者中的临床意义尚不清楚。本研究旨在探讨 NREM-AHI＞REM-AHI 组与 REM-AHI＞NREM-AHI 组之间在临床和多导睡眠图特征方面是否存在显著差异，并确定 NREM-AHI＞REM-AHI 或 REM-AHI＞NREM-AHI 是否是一种特定的临床实体。

方法

对 142 例 OSA 患者（包括 114 名男性和 28 名女性）进行半结构式临床问卷评估特定的睡眠相关症状、Epworth 嗜睡量表（ESS）评估日间嗜睡、贝克抑郁量表（BDI）评估抑郁、医疗结局研究 36 项简短健康调查问卷（SF-36）评估健康相关生活质量。检查 NREM-AHI＞REM-AHI 患者和 REM-AHI＞NREM-AHI 患者之间的人体测量、临床和多导睡眠图特征。

结果

在 142 例 OSA 患者中，有 54.9%的患者出现 NREM-AHI 高于 REM-AHI。总体而言，男性在每个组中均占优势，并且在 NREM-AHI＞REM-AHI 组和 REM-AHI＞NREM-AHI 组之间，年龄、体重指数、病史和药物摄入无显著差异。在每个组中，中重度 OSA 患者中 NREM-AHI＞REM-AHI（94.9%）或 REM-AHI＞NREM-AHI（90.6%）的发生率较高。尽管 NREM-AHI＞REM-AHI 组的一些 OSA 指标比 REM-AHI＞NREM-AHI 组差，但两组之间在特定的睡眠相关症状、ESS 评分、BDI 评分、日间嗜睡或抑郁的发生率、SF-36 各子维度和总分方面均无显著差异。分别比较时，两组男性和女性的临床特征无显著差异。

结论

我们的研究结果表明，NREM-AHI＞REM-AHI 或 REM-AHI＞NREM-AHI 在中重度 OSA 病例中更为常见，并且在 NREM-AHI＞REM-AHI 组和 REM-AHI＞NREM-AHI 组之间，临床特征无显著差异。这些发现可能表明，NREM-AHI＞REM-AHI 或 REM-AHI＞NREM-AHI 应被视为 OSA 谱的一部分，而不是一种特定的临床实体。