Carissimi Alicia, Martinez Denis, Kim Lenise J, Fiori Cintia Z
Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil,
Sleep Breath. 2014 Sep;18(3):499-507. doi: 10.1007/s11325-013-0911-7. Epub 2013 Nov 27.
To examine whether in obstructive sleep apnea (OSA) patients the degree of sleepiness, slow-wave sleep (SWS) loss, and hypoxia influence the response of psychological symptoms to continuous positive airway pressure (CPAP) therapy.
A prospectively planned cohort was assessed. Participants underwent full overnight polysomnography. All answered the Symptom Checklist-90-Revised (SCL-90) and the Epworth sleepiness scale (ESS). Only cases with an apnea-hypopnea index ≤60 events/h were 24 invited to participate. In an interview by telephone, after a follow-up period between 2 months and 1 year, patients informed whether they were in treatment with CPAP or remained voluntarily untreated. Subjects who accepted to participate answered for the second time the SCL-90 and the ESS. The baseline variables of interest were: (a) score of the ESS, (b) duration of SWS, and (c) time with arterial oxygen saturation below 90%. The outcomes were the change in SCL-90 scores in all dimensions and indices of the questionnaire.
A number of 73 patients, mostly men, were included. In uncontrolled analyses, CPAP-treated patients showed significant improvement at follow-up in 10 of the 13 SCL-90 scores. Comparing with the control group, only six scores were improved. Baseline sleepiness was the best predictor of SCL-90 improvement after CPAP treatment in the univariate analyses, and the only significant predictor of improvement in a multivariate regression model.
Sleepiness may supersede other factors that influence psychological improvement in CPAP-treated patients with severe OSA.
探讨阻塞性睡眠呼吸暂停（OSA）患者的嗜睡程度、慢波睡眠（SWS）缺失及低氧血症是否会影响心理症状对持续气道正压通气（CPAP）治疗的反应。
对一个前瞻性规划的队列进行评估。参与者接受整夜多导睡眠监测。所有人均填写症状自评量表90修订版（SCL - 90）和爱泼沃斯嗜睡量表（ESS）。仅邀请呼吸暂停低通气指数≤60次/小时的患者参与。在2个月至1年的随访期后通过电话访谈，患者告知是否正在接受CPAP治疗或仍自愿未治疗。接受参与的受试者再次填写SCL - 90和ESS。感兴趣的基线变量为：（a）ESS评分，（b）SWS持续时间，（c）动脉血氧饱和度低于90%的时间。结果为问卷所有维度和指标中SCL - 90评分的变化。
纳入73例患者，多数为男性。在未进行对照分析时，接受CPAP治疗的患者在随访时SCL - 90的13项评分中有10项显著改善。与对照组相比，仅有6项评分得到改善。在单因素分析中，基线嗜睡程度是CPAP治疗后SCL - 90改善的最佳预测指标，且在多因素回归模型中是唯一显著的改善预测指标。
嗜睡可能取代其他影响重度OSA患者接受CPAP治疗后心理改善的因素。
