Miao Z B, Wang Y Y, Sun R, Lei H L, Huang D J, Huang L H, Fan C Y, Lü Y H
Sleep Medicine Center, the Affiliated First People's Hospital of Yunnan Province of Kunming University of Science And Technology, Kunming 650504, China.
Zhonghua Yi Xue Za Zhi. 2017 Mar 28;97(12):915-919. doi: 10.3760/cma.j.issn.0376-2491.2017.12.008.
To investigate the incidence of treatment-emergent central sleep apnea (TE-CSA), the characteristics of demography and the influencing factors in patients with obstructive sleep apnea syndrome (OSAS) after initial continuous positive airway pressure (CPAP) titration at high altitude. Clinical data of 297 patients with OSAS which living in plateau areas (1 000 meters or more above sea level) were retrospectively analyzed in this study from January to December, 2015. All of these patients taken an overnight CPAP titration in the Sleep Medicine Center of First People's Hospital of Yunnan Province. They were classified as with TE-CSA group and non TE-CSA group according to the outcome of CPAP titration. Comparisons of demographic characteristic, parameters of polysomnography in CPAP titration night, lung function test and blood gas analysis were made between the two groups, respectively, and statistical analysis was carried. The incidence of TE-CSA was 16.5% (49/297) after initial CPAP titration at high altitude, which was higher in male patients (18.2% vs 6.8%, =0.061). The incidence of TE-CSA decreased with the increase of age and body mass index (BMI), and the decrease of resident altitude. Multivariate Logistic regression analysis showed that the resident altitude, mixed apnea index (MAI), forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) ratio, functional residual capacity (RV) and total lung capacity (TLC) ratio were the main factors affecting the occurrence of TE-CSA. Among them, the increase of resident altitude and MAI were risk factors [=1.16(1.02, 1.32), 1.05(1.01, 1.09)]. The increase of FEV(1)/FVC and RV/TLC were protective factors [=0.94(0.89, 0.98), 0.94(0.88, 0.99)]. The incidence of TE-CSA is high at high altitude area, and the increase of resident altitude and MAI are the risk factors for TE-CSA.
为探讨高原地区阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者初次持续气道正压通气（CPAP）滴定后治疗性中枢性睡眠呼吸暂停（TE-CSA）的发生率、人口学特征及影响因素。本研究回顾性分析了2015年1月至12月在高原地区（海拔1000米及以上）居住的297例OSAS患者的临床资料。所有患者均在云南省第一人民医院睡眠医学中心进行了整夜CPAP滴定。根据CPAP滴定结果将其分为TE-CSA组和非TE-CSA组。分别比较两组的人口学特征、CPAP滴定夜多导睡眠图参数、肺功能检查及血气分析结果，并进行统计学分析。高原地区初次CPAP滴定后TE-CSA的发生率为16.5%（49/297），男性患者发生率较高（18.2%对6.8%，P=0.061）。TE-CSA的发生率随年龄、体重指数（BMI）的增加及居住海拔的降低而降低。多因素Logistic回归分析显示，居住海拔、混合性呼吸暂停指数（MAI）、第1秒用力呼气容积（FEV(1)）与用力肺活量（FVC）比值、功能残气量（RV）与肺总量（TLC）比值是影响TE-CSA发生的主要因素。其中，居住海拔和MAI的增加是危险因素[OR=1.16(1.02, 1.32)，1.05(1.01, 1.09)]。FEV(1)/FVC和RV/TLC的增加是保护因素[OR=0.94(0.89, 0.98)，0.94(0.88, 0.99)]。高原地区TE-CSA的发生率较高，居住海拔的增加和MAI是TE-CSA的危险因素。
