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目的用临界压(Pcrit)来提示男性与女性睡眠呼暂停低通气综合症(SAHS)患者发病方式上的差别,进而用于指导临床治疗。方法分别对202名男性、66名女性进行多导睡眠图(PSG)检查;用压力振荡技术(Forced oscillation technique, FOT)在患者平卧位快动眼睡眠Ⅱ期对通气量与压力的关系,用外推法在气流为零时作图解出Pcrit。并对SAHS3组中的男性及女性患者试用持续正压通气(CPAP)治疗。结果Pcrit在女性SAHS1组为(0.8±0.7)cmH2O,SAHS2组为(1.4±0.6)cmH2O,SAHS3组为(1.4±1.2)cmH2O,三组间无显著意义;而Pcrit在男性SAHS1组为(1.2±0.6)cmH2O,SAHS2组为(1.7±0.8)cmH2O,SAH3组为(2.4±0.8)cmH2O,三组间比较均有非常显著增高的意义。男性SAH3组患者的Pcrit亦显著地高于女性SAH3组患者;并且Pcrit与男性SAH3组患者的OAI、MAI呈非常显著正相关;而男性患者的OAI、MAI又与BMI均呈非常显著正相关。女性患者Pcrit与OAI、MAI及OHI均无相关关系,但女性患者OHI与BMI显著正相关。SAH3组男性及女性患者接受CPAP治疗的顺应性分别为40.6%及10.5%。结论Pcrit能从功能上反映男性SAHS患者睡眠时咽部塌陷的程度;女性患者以OH为主,Pcrit较小,咽部塌陷较轻;这对临床治疗有一定的指导意义。
Objective To use the critical pressure (Pcrit) to suggest differences in the pathogenesis of sleep apnea-hypopnea syndrome (SAHS) between men and women and to guide clinical treatment. Methods Polysomnography (PSG) was performed in 202 males and 66 females respectively. The relationship between ventilation volume and pressure in fast-moving eyes Ⅱ during supine position was measured by Forced Oscillatory Surgery (FOT) Use extrapolation to plot Pcrit at zero airflow. Continuous positive pressure ventilation (CPAP) was used in both male and female SAHS3 patients. Results Pcrit was (0.8 ± 0.7) cmH2O in SAHS1 group, (1.4 ± 0.6) cmH2O in SAHS2 group, and (1.4 ± 1.2) cmH2O in SAHS3 group. There was no significant difference among the three groups ± 0.6 cmH2O, SAHS2 group was (1.7 ± 0.8) cmH2O, and SAH3 group was (2.4 ± 0.8) cmH2O. There was a significant increase in all three groups. The Pcrit in male SAH3 group was significantly higher than that in female SAH3 group. There was a significant positive correlation between Pcrit and OAI and MAI in male SAH3 group. There was a significant positive correlation between OAI and MAI and BMI in male patients. There was no correlation between Pcrit and OAI, MAI and OHI in female patients, but there was a significant positive correlation between OHI and BMI in female patients. The compliance of CPAP with male and female patients in the SAH3 group was 40.6% and 10.5%, respectively. Conclusions Pcrit can reflect the extent of pharyngeal collapse during sleep in male patients with SAHS. Female patients are predominantly OH, with smaller Pcrit and less collapse of the pharynx. This is of clinical significance.