University of Texas Health Science Center at Houston, Houston, TX ; Memorial Hermann Hospital-Texas Medical Center Sleep Disorders Center, Houston, TX.
J Clin Sleep Med. 2014 Apr 15;10(4):391-6. doi: 10.5664/jcsm.3612.
The study was performed to evaluate the hypothesis that the extremely obese manifest sleep disordered breathing with a preponderance of hypopneas and relative paucity of obstructive apneas.
Retrospective review of 90 adults with obstructive sleep apnea-hypopnea syndrome (OSAHS) matched for age and gender, comparing two groups, Group A: body mass index (BMI) < 35, Group B: BMI ≥ 45.
age < 18 years, pregnancy, ≥ 5 central apneas/hour, BMI ≥ 35 < 45.
Hypopnea/apnea ratio (HAR); secondary measures: obstructive apnea-hypopnea index (AHI), obstructive and central apnea indices, hypopnea index (HI), oxygen saturation (SpO2) nadir, end-tidal carbon dioxide tension (PetCO2), and presence of obesity-hypoventilation syndrome (OHS).
t-test for independent samples; Mann-Whitney, linear regression with natural log transformation, and Kruskal-Wallis χ(2). Descriptive statistics were expressed as interquartile range, median and mean ± standard deviation, p < 0.05 considered significant.
Group A (n = 45): age = 50.6 ± 11.5 years, BMI = 28.9 ± 4 kg/m(2); Group B (n = 45): age = 47.4 ± 12.7 years, BMI = 54.5 ± 8 kg/m(2). HAR was significantly higher in Group B (38.8 ± 50.7) than Group A (10.6 ± 16.5), p = 0.0006, as was HI (28.7 ± 28.6 in B vs 12.6 ± 8.4 in A, p = 0.0005) and AHI (35.5 ± 33.8 vs 22 ± 23, p = 0.03), but not apnea index. HAR was significantly higher in Group B regardless of race, gender, or presence of OHS. The BMI was the only significant predictor of HAR (adjusted r(2) = 0.138; p = 0.002) in a linear regression model with natural log transformation of the HAR performed for age, gender, race, BMI, and PetCO2.
Extremely obese patients manifest OSAHS with a preponderance of hypopneas.
本研究旨在验证下述假说，即极度肥胖者的睡眠呼吸紊乱以频繁发生的低通气和相对较少的阻塞性呼吸暂停为特征。
对 90 例阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者进行回顾性分析，这些患者按年龄和性别进行匹配，分为两组：A 组：体重指数（BMI）<35；B 组：BMI≥45。
年龄<18 岁、妊娠、每小时≥5 次中枢性呼吸暂停、BMI≥35<45。
低通气/呼吸暂停比（HAR）；次要观察指标：阻塞性呼吸暂停低通气指数（AHI）、阻塞性和中枢性呼吸暂停指数、低通气指数（HI）、氧饱和度（SpO2）最低值、呼气末二氧化碳分压（PetCO2）和肥胖低通气综合征（OHS）的存在。
独立样本 t 检验；Mann-Whitney、自然对数转换的线性回归和 Kruskal-Wallis χ(2)检验。描述性统计以四分位间距、中位数和均值±标准差表示，p<0.05 为差异有统计学意义。
A 组（n=45）：年龄=50.6±11.5 岁，BMI=28.9±4kg/m(2)；B 组（n=45）：年龄=47.4±12.7 岁，BMI=54.5±8kg/m(2)。B 组的 HAR（38.8±50.7）显著高于 A 组（10.6±16.5），p=0.0006，HI（28.7±28.6 比 12.6±8.4，p=0.0005）和 AHI（35.5±33.8 比 22±23，p=0.03）也显著更高，但呼吸暂停指数无显著差异。无论种族、性别或 OHS 存在与否，B 组的 HAR 均显著更高。在对年龄、性别、种族、BMI 和 PetCO2 进行自然对数转换的 HAR 线性回归模型中，BMI 是 HAR 的唯一显著预测因子（调整 r(2)=0.138；p=0.002）。
极度肥胖患者的 OSAHS 以频繁发生的低通气为特征。
