Yuan Yuqi, Liu Haiqin, Liu Na, Si Chao, Ren Xiaoyong
Department of Otolaryngology Head and Neck Surgery，the Second Affiliated Hospital of Xi'anJiaotong University，Xi'an，710004，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Apr;36(4):278-285. doi: 10.13201/j.issn.2096-7993.2022.04.008.
This study sought to explore the effect of age on arousal index in patients with OSAHS, and the significance of arousal index among different phenotypes identified through cluster analysis according to clinical symptoms and complications. A total of 607 adult patients with OSAHS who received polysomnography in the Second Affiliated Hospital of Xi'an Jiaotong University from July 2020 to July 2021 were selected. All patients registered basic human data, symptoms, complaints and complications, completed the Epworth Sleepiness Scale. We explored the distribution of several PSG parameters in different age groups, and included typical symptoms and complications into cluster analysis to explore the parameter differences in patients with different phenotypes. Young patients had the lowest arousal index and arousal frequency in NREM stage, in middle-aged patients, the arousal index was relatively higher, the arousal times during NREM with oxygen desaturation were the highest. Among elderly patients, the wakefulness after sleep onset（WASO） was the longest, the arousal times in REM sleep was the lowest, and the spontaneous arousal times in NREM sleep were the highest（<0.05）. Among the 3 types according to the cluster analysis, phenotype Ⅰwas characterised by maximally complications, excessive daytime sleepiness and obesity, while memory and attention impairment were obvious in phenotype Ⅱ. Phenotype Ⅲhad minimal complications, relatively better mental state with shorter time-course of snoring and apnea. Phenotype I differed significantly by higher severity, more severe hypoxemia, higher arousal index and longer WASO time（<0.05）. the arousal index distribution varies among OSAHS patients with different age, and cluster analysis shows that patients with severe symptoms and more complications tend to have higher arousal index.
本研究旨在探讨年龄对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者觉醒指数的影响，以及根据临床症状和并发症通过聚类分析确定的不同表型中觉醒指数的意义。选取了2020年7月至2021年7月在西安交通大学第二附属医院接受多导睡眠监测的607例成年OSAHS患者。所有患者均登记基本人口学数据、症状、主诉和并发症，完成爱泼华嗜睡量表。我们探讨了不同年龄组几个多导睡眠图参数的分布情况，并将典型症状和并发症纳入聚类分析，以探讨不同表型患者的参数差异。年轻患者在非快速眼动（NREM）期的觉醒指数和觉醒频率最低，中年患者的觉醒指数相对较高，NREM期伴有氧饱和度下降时的觉醒次数最高。老年患者中，睡眠后觉醒时间（WASO）最长，快速眼动（REM）睡眠期的觉醒次数最低，NREM睡眠期的自发觉醒次数最高（P<0.05）。根据聚类分析的3种类型中，表型Ⅰ的特点是并发症最多、日间过度嗜睡和肥胖，而表型Ⅱ的记忆和注意力损害明显。表型Ⅲ的并发症最少，精神状态相对较好，打鼾和呼吸暂停的病程较短。表型Ⅰ在严重程度、更严重的低氧血症、更高的觉醒指数和更长的WASO时间方面有显著差异（P<0.05）。OSAHS患者的觉醒指数分布在不同年龄之间有所不同，聚类分析表明，症状严重且并发症较多的患者往往有较高的觉醒指数。
