Noda A, Okada T, Yasuma F, Sobue T, Nakashima N, Yokota M
Nagoya University School of Health Sciences, Department of Clinical Laboratory Medicine, Nagoya University Hospital, Japan.
Psychiatry Clin Neurosci. 1998 Feb;52(1):79-85. doi: 10.1111/j.1440-1819.1998.tb00977.x.
The long-term natural course of obstructive sleep apnea syndrome (OSAS) is studied in order to determine whether severity of nocturnal oxygen desaturation associated with apnea/hypopnea, body mass index (BMI), and hypertension influence survival in young (<40 years), middle-aged (40-64 years), and aged (> or = 65 years) using a questionnaire survey. One hundred and forty-eight patients with OSAS aged 17-78 years (136 men, 12 women, mean 52.0+/-12.3 years), who were diagnosed by standard polysomnography (PSG) between 1983 and 1993, participated in the study. The survey revealed 15 deaths and 101 survivors; 32 subjects could not be located. The survival rate was 71.4% (95% confidence interval: 55.6-87.2%). The survival rate in patients with OSAS was significantly lower than that in the age and sex-adjusted control Japanese population (87.6%). In the young group, only one death (a 19-year-old woman) occurred unexpectedly during sleep. The patient showed an apnea/hypopnea index (AHI) of 33 per h and the length of time that the nocturnal oxygen saturation (SaO2) fell below 90% (time of SaO2 <90%) of 205 min. The survival rate in middle-aged patients with OSAS was significantly lower than that in the age and sex-adjusted control Japanese population (79.2 vs 91.0%), but this pattern was not seen among the aged. Time of SaO2 <90% was significantly longer in the middle-aged patients than in the aged patients, but AHI did not differ between the two groups. Moreover, it was significantly correlated with AHI in middle-aged patients, but not in the aged patients. The survival rate was significantly lower in patients with hypertension than in the patients without such complications in the middle-aged group (57.9 vs 90.4%). Cox proportional-hazard regression model including age, hypertension, BMI, AHI, lowest SaO2, and time of SaO2 <90% showed that hypertension was only significantly associated with lower survival rate in total group and middle-aged patients, but not in the young or aged patients. The prognosis in patients with OSAS may differ among the generations. The prognosis in the middle-aged population may depend on the role of OSAS on the complications of hypertension or severity of oxygen desaturation, but not on AHI only.
为了确定与呼吸暂停/低通气相关的夜间氧饱和度降低的严重程度、体重指数（BMI）和高血压是否会影响年轻（<40岁）、中年（40 - 64岁）和老年（≥65岁）人群的生存情况，我们通过问卷调查研究了阻塞性睡眠呼吸暂停综合征（OSAS）的长期自然病程。1983年至1993年间经标准多导睡眠图（PSG）诊断的148例年龄在17 - 78岁的OSAS患者（136名男性，12名女性，平均年龄52.0±12.3岁）参与了这项研究。调查发现15例死亡病例和101例存活者；32名受试者无法联系到。生存率为71.4%（95%置信区间：55.6 - 87.2%）。OSAS患者的生存率显著低于年龄和性别调整后的日本对照人群（87.6%）。在年轻组中，仅1例（一名19岁女性）在睡眠中意外死亡。该患者的呼吸暂停/低通气指数（AHI）为每小时33次，夜间氧饱和度（SaO2）低于90%的时间（SaO2<90%的时间）为205分钟。中年OSAS患者的生存率显著低于年龄和性别调整后的日本对照人群（79.2%对91.0%），但老年组未出现这种情况。中年患者的SaO2<90%的时间显著长于老年患者，但两组的AHI无差异。此外，中年患者中该时间与AHI显著相关，而老年患者中则不然。中年组中患有高血压的患者生存率显著低于无此类并发症的患者（57.9%对90.4%）。包含年龄、高血压、BMI、AHI、最低SaO2和SaO2<90%时间的Cox比例风险回归模型显示，高血压仅与总人群和中年患者的较低生存率显著相关，而与年轻或老年患者无关。OSAS患者的预后可能因代际不同而有所差异。中年人群的预后可能取决于OSAS对高血压并发症或氧饱和度降低严重程度的影响，而不仅仅取决于AHI。
