【摘要】：阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)是成人睡眠呼吸障礙(sleep-disordered breathing,SDB)中最常見的一種,可導(dǎo)致患者白天嗜睡,心腦肺血管并發(fā)癥乃至多臟器損害。目前,我國大陸地區(qū)OSAHS的流行病學(xué)資料較為有限,僅上海、承德、太原、福州有相關(guān)大樣本報(bào)道。如果采用診斷OSAHS的“金標(biāo)準(zhǔn)”對(duì)所有被調(diào)查者進(jìn)行全夜多導(dǎo)睡眠圖(polysomnography,PSG)監(jiān)測,費(fèi)時(shí)且成本極大。故本研究首先對(duì)便攜式睡眠監(jiān)測(portable monitor,PM)和PSG監(jiān)測的差異性做出評(píng)估,在確定其準(zhǔn)確度的基礎(chǔ)上對(duì)篩查出的OSAHS可疑人群行PM,以此得出廣州市區(qū)OSAHS的患病率,為制定相關(guān)防治策略提供依據(jù)。 第一部分便攜式睡眠監(jiān)測和多導(dǎo)睡眠監(jiān)測的差異性研究 目的 比較PM與PSG兩種監(jiān)測方法在臨床上診斷OSAHS的差異性,為評(píng)估PM篩查OSAHS的診斷價(jià)值提供依據(jù)。 方法 納入有夜間打鼾,伴或不伴呼吸暫停的患者,仔細(xì)詢問病史(白天的精神狀況,有無其他睡眠疾病或慢性疾病史)。患者先于我院睡眠中心行PSG監(jiān)測,后由專業(yè)的睡眠技術(shù)人員對(duì)其指導(dǎo)PM的使用方法及注意事項(xiàng),于家中自行監(jiān)測睡眠狀況。將兩組監(jiān)測結(jié)果進(jìn)行統(tǒng)計(jì)分析,比較其各主要參數(shù)的差異性,并分析PM的診斷OSAHS的準(zhǔn)確度。 結(jié)果 1.入選50例疑似OSAHS的患者,其中男性46例,女性4例,平均年齡44.86±11.22歲,35-60歲的有30例,患者平均體重指數(shù)(body mass index,BMI)為26.64±3.17。 2. PM與PSG在監(jiān)測睡眠呼吸暫停低通氣指數(shù)(apnea-hypopnea index,AHI)、氧減指數(shù)、夜間最低血氧飽和度、平均血氧飽和度等參數(shù)上無明顯差異(P0.05),PM的靈敏度為97.62%,特異度為75%,陽性似然比為3.9048,陰性似然比為0.0317,陽性預(yù)測價(jià)值為0.1078,陰性預(yù)測價(jià)值為0.9990。 3. PM與PSG測得AHI的一致性由Bland-Altman plot得出。 結(jié)論 PM與PSG兩種方法監(jiān)測的主要參數(shù)的差異性無統(tǒng)計(jì)學(xué)意義,PM靈敏度較高但特異度較低,故針對(duì)一些有明顯OSAHS癥狀的疑似患者可進(jìn)行篩查,有一定診斷意義。 第二部分廣州市區(qū)阻塞性睡眠呼吸暫停低通氣綜合征流行病學(xué)調(diào)查 目的 了解廣州市區(qū)OSAHS的患病率,為宣傳及防治該疾病的危害性提供參考數(shù)據(jù)。 方法 采用整群抽樣的方法對(duì)廣州市的越秀區(qū)、天河區(qū)、荔灣區(qū)、海珠區(qū)、白云區(qū)、羅崗區(qū)、番禺區(qū)、黃埔區(qū)8個(gè)區(qū)的常住居民共7684人,進(jìn)行入戶問卷調(diào)查,篩選出Epworth嗜睡量表(epworth sleepiness scale,ESS)總分≥9分的人群,對(duì)其中中重度打鼾人群行PM,估算出人群OSAHS的患病率。 結(jié)果 實(shí)際完成調(diào)查問卷6712份,應(yīng)答率87.35%,有效問卷5620份,有效率為83.73%,ESS總分≥9分的共363例(6.46%),其中90例伴中重度打鼾,73例同意行PM。ESS總分≥9分在≤30歲和40-49歲兩個(gè)年齡組人數(shù)最多,女性人數(shù)多于男性,但男性普遍總分較高。吸煙、飲酒與ESS評(píng)分相關(guān)。公眾對(duì)OSAHS的認(rèn)知程度偏低。按AHI≥5次/h且ESS總分≥9分為診斷標(biāo)準(zhǔn),估算出人群OSAHS患病率為1.45%。 結(jié)論 廣州市OSAHS的患病率為1.45%。公眾對(duì)OSAHS的認(rèn)知程度偏低,應(yīng)積極宣傳其危害性,引起醫(yī)務(wù)工作者和大眾的足夠重視。
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) is the most common type of adult sleep and respiratory disorder (sleep-disordered breathing, SDB), which can lead to daytime sleepiness, cardiovascular and pulmonary vascular complications and even multiple organs damage. Currently, the epidemiology of OSAHS in the mainland of China Shanghai, Chengde, Taiyuan, and Fuzhou have relatively large sample reports. If the "gold standard" for diagnostic OSAHS is used to monitor all night polysomnography (polysomnography, PSG) for all the respondents, it is time-consuming and costly. This study first made the difference between portable monitor (PM) and PSG monitoring. On the basis of the assessment, PM was performed on the screened OSAHS suspected population on the basis of its accuracy, so as to obtain the prevalence of OSAHS in Guangzhou City, and to provide the basis for the formulation of relevant prevention and control strategies.
The first part is the difference between portable sleep monitoring and polysomnography.
objective
To compare the difference between the two monitoring methods of PM and PSG in clinical diagnosis of OSAHS, so as to provide basis for evaluating the diagnostic value of PM screening for OSAHS.
Method
The patients who had nocturnal snoring, accompanied by or without apnea, were carefully inquiring about the history of the disease (the mental state of the day, with or without other sleep or chronic disease history). The patients were monitored by PSG in the sleep center of our hospital, and then the professional sleep technicians monitored the use of PM and the precautions of their use and monitored their sleep conditions at home. Two groups of monitoring results were statistically analyzed, compared the difference of their main parameters, and analyzed the accuracy of PM diagnosis OSAHS.
Result
1. patients were enrolled in 50 cases of suspected OSAHS, of which 46 were male, 4 were female, the average age was 44.86 + 11.22 years, and 35-60 years old, and the average body mass index (body mass index, BMI) was 26.64 + 3.17..
There was no significant difference between 2. PM and PSG in monitoring sleep apnea hypopnea index (apnea-hypopnea index, AHI), oxygen subtraction index, minimum oxygen saturation at night and average oxygen saturation (P0.05). The sensitivity of PM was 97.62%, the specificity was 75%, the positive likelihood ratio was 3.9048, the negative likelihood ratio was 0.0317, the positive predictive value was 0.1078, Yin was negative. The predictive value of sex is 0.9990.
3. the consistency of AHI measured by PM and PSG is derived from Bland-Altman plot.
conclusion
The difference between the main parameters of the two methods of PM and PSG is not statistically significant, the sensitivity of PM is high, but the specificity is low, so it can be screened for some suspected patients with obvious OSAHS symptoms and has certain diagnostic significance.
The second part is the epidemiological survey of obstructive sleep apnea hypopnea syndrome in Guangzhou.
objective
Objective to understand the prevalence of OSAHS in urban areas of Guangzhou, and to provide reference data for publicizing and preventing the disease.
Method
By cluster sampling, 7684 people living in 8 districts of Yuexiu District, Tianhe District, Liwan District, Haizhuqu District, Baiyun District, Luo Gang District, Panyu District and Whampoa district were surveyed by questionnaire, and the total score of Epworth Sleepiness Scale (ESS) (Epworth scale, ESS) was more than 9, and PM was used to estimate the moderate and severe snoring population. Calculate the prevalence of OSAHS in the crowd.
Result
6712 questionnaires were completed, the response rate was 87.35%, the effective questionnaire was 5620, the effective rate was 83.73%, and the total score of ESS was more than 9 (6.46%). Among them, 90 cases were snoring with moderate to severe snoring and 73 agreed that the total score of the PM.ESS total score was more than 9 in the two age groups of less than 30 years and 40-49 years, and the number of women was more than that of men, but the general total score of male was higher. Smoking and drinking were higher. Alcohol is associated with ESS score. The public is less aware of OSAHS. According to AHI > 5 /h and ESS total score of 9 or more as diagnostic criteria, the OSAHS prevalence rate is estimated to be 1.45%..
conclusion
The prevalence rate of OSAHS in Guangzhou is 1.45%.. The public is less aware of OSAHS. We should actively publicize its harmfulness and attract enough attention from medical workers and the public.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R766

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本文編號(hào)：2128792