【摘要】： 阻塞性睡眠呼吸暫停低通氣綜合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是睡眠期間反復出現(xiàn)的、短暫的、可逆的上氣道狹窄或阻塞,引起呼吸暫停或低通氣,有時伴有鼾聲,引起日間過度嗜睡表現(xiàn)的一組癥候群。鼾癥(snoring disease)是鼾聲響度超過60分貝以上,妨礙上呼吸道呼吸氣流通過,影響同室人休息或?qū)е滤藷⿶赖牟“Y。打鼾是阻塞性睡眠呼吸暫停低通氣綜合征的一個十分突出的癥狀。 鼾癥和OSAHS是呼吸系統(tǒng)的常見病和多發(fā)病,涉及到各年齡段人群,鼾癥患病率為3%～48%;一般嬰幼兒OSAHS的患病率為1%～3%,成年人OSAHS的患病率為2%～4%,而老年人OSAHS的患病率高達為20%～40%。鼾癥與OSAHS主要是睡眠期間頻繁呼吸暫停與低通氣,引起慢性間歇低氧、高碳酸血癥、胸腔負壓增大、反復微覺醒及睡眠結(jié)構(gòu)異常,導致自主神經(jīng)功能紊亂、氧化應激及炎癥反應、血管內(nèi)皮細胞損傷、血流粘度增高、高凝狀態(tài)、纖溶系統(tǒng)異常、泌尿生殖及內(nèi)分泌代謝異常等一系列的臨床癥狀及并發(fā)癥。目前認為鼾癥和OSAHS屬于全身性疾病,而且作為心腦肺等血管疾病及代謝綜合征等疾病的獨立危險因素逐漸受到重視,并成為研究的熱點;未經(jīng)過治療的鼾癥與OSAHS患者睡眠中猝死增加。但鼾癥和OSAHS屬于慢性疾病,人們包括少數(shù)醫(yī)務工作者在內(nèi)對其所導致的心腦肺血管并發(fā)癥乃至多臟器損害或疾病還缺乏足夠的認識。 He J等對未治療的OSAHS患者進行隨訪,發(fā)現(xiàn)AHI20次/h者5年病死率為11%～13%,8年病死率高達37%,而經(jīng)氣道切開和持續(xù)氣道正壓通氣(CPAP)治療者無1例死亡,而經(jīng)過懸雍垂腭咽成形術(shù)(UPPP)治療者6例死亡。鼾癥與OSAHS嚴重影響患者的勞動能力、生活質(zhì)量和生存率,并造成社會的重大經(jīng)濟負擔。 為此,本研究對2002年承德市區(qū)鼾癥和OSAHS調(diào)查人群進行7年隨訪,探討鼾癥和OSAHS對人群健康的影響,觀察鼾癥與非鼾癥人群7年隨訪期間不同并發(fā)癥的發(fā)病率和死亡率,分析其危險因素,并比較未接受治療的OSAHS患者隨訪前后睡眠監(jiān)測及臨床特點的變化,為該病的防治提供理論依據(jù)。本研究包括兩個部分: 第一部分:承德市區(qū)居民鼾癥和非鼾癥人群7年隨訪研究 第二部分:阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠監(jiān)測特點分析第一部分承德市區(qū)居民鼾癥和非鼾癥人群7年隨訪研究 目的: 探討鼾癥對人群健康的影響,觀察鼾癥和非鼾癥人群7年隨訪期間不同并發(fā)癥的發(fā)病率和死亡率,分析其危險因素,為該病的防治提供理論依據(jù)。 方法: 研究對象為2002年承德市區(qū)進行的鼾癥和OSAHS流調(diào)人群1168人,于2009年2月～5月對其進行追蹤隨訪,再次設計問卷進行入戶調(diào)查。鼾癥組共298人(包括死亡27人),非鼾癥組共764人(包括死亡24人)。非鼾癥組中有144人在7年隨訪期間出現(xiàn)鼾癥(鼾級≥2級)。比較鼾癥和非鼾癥組7年隨訪期間并發(fā)癥的發(fā)病率和死亡率,分析非鼾癥組7年隨訪期間出現(xiàn)鼾癥的危險因素(logistic回歸分析),并進行認知情況比較。 結(jié)果: 1.鼾癥組與非鼾癥組7年隨訪期間不同并發(fā)癥的發(fā)病率比較: 鼾癥組7年隨訪期間高血壓的發(fā)病率顯著高于非鼾癥組,分別為75.6%和17.4%,兩組比較差異有統(tǒng)計學意義(P0.01);冠心病發(fā)病率分別為25.8%和7.2%,兩組比較差異有統(tǒng)計學意義(P0.01);腦血管病發(fā)病率分別為21.8%和5.7%,兩組比較差異有統(tǒng)計學意義(P0.01);糖尿病發(fā)病率分別為19.2%和4.2%,兩組比較差異有統(tǒng)計學意義(P0.01);慢性腎臟病發(fā)病率分別為4.1%和0.5%,兩組比較差異有統(tǒng)計學意義(P0.01)。 2.鼾癥組與非鼾癥組死于各種疾病的死亡率比較: 調(diào)查人群中共死亡51人,其中,鼾癥組死亡27人,非鼾癥組死亡24人,鼾癥組的死亡率顯著高于非鼾癥組,分別為9.06%和3.87%,兩組比較差異有統(tǒng)計學意義(P0.01)。其中,鼾癥組和非鼾癥組死于腫瘤的死亡率分別為2.3%和0.6%,兩組比較差異有統(tǒng)計學意義(P0.05);腦血管病的死亡率分別為3.7%和1.0%,兩組比較差異有統(tǒng)計學意義(P0.01);心血管病死亡率分別為3.0%和1.5%,兩組比較差異無統(tǒng)計學意義(P0.05)。 3.非鼾癥組7年隨訪期間出現(xiàn)鼾癥的危險因素logistic回歸分析:打鼾家族史、吸煙指數(shù)、體重指數(shù)與其鼾癥的發(fā)生顯著相關(guān)(P0.01),年齡與鼾癥的發(fā)生相關(guān)(P0.05)。 4.鼾癥認知情況:人群認為打鼾是病且需要治療的2002年為25.34%,2009年為23.44%,兩次調(diào)查結(jié)果比較,差異無統(tǒng)計學意義(P0.05)。 結(jié)論: 鼾癥是高血壓、冠心病、腦血管病、糖尿病和慢性腎臟病等疾病的高危因素。鼾癥人群死亡率明顯高于非鼾癥人群。打鼾家族史、吸煙指數(shù)、體重指數(shù)、年齡是鼾癥發(fā)生的危險因素。人們對鼾癥與OSAHS的疾病認知情況仍沒有明顯改善。因此,應進一步加大宣傳力度。 第二部分阻塞性睡眠呼吸暫停低通氣綜合征患者睡眠監(jiān)測特點分析 目的: 分析未接受治療的OSAHS患者7年隨訪前后睡眠監(jiān)測及臨床特點的變化。 方法: 研究對象為2002年承德市區(qū)流調(diào)及應用便攜式睡眠監(jiān)測儀確診的99例OSAHS患者,包括中年組63例(男45例,女18例),老年組36例(男22例,女14例),均未接受治療,7年后再次隨訪,行睡眠呼吸監(jiān)測并分析其臨床特點變化。 結(jié)果: 1.中年組和老年組7年前后嚴重程度和臨床特點的變化 中年組OSAHS患者夜間憋醒的發(fā)生率高于老年組,差異有統(tǒng)計學意義(P0.05);中年組OSAHS患者白天嗜睡發(fā)生率與老年組比較,差異無統(tǒng)計學意義(P0.05);老年組OSAHS患者高血壓的發(fā)生率高于中年組,差異有統(tǒng)計學意義(P0.05);老年組OSAHS患者冠心病、腦血管病、糖尿病的發(fā)生率顯著高于中年組,差異有統(tǒng)計學意義(P0.01);中年組OSAHS患者的嚴重程度較7年前明顯加重,差異有統(tǒng)計學意義(P0.01);老年組OSAHS患者的嚴重程度較7年前有加重趨勢,但差異無統(tǒng)計學意義(P0.05)。 2.中年組和老年組OSAHS患者7年前后睡眠監(jiān)測指標變化 (1)自身前后比較: 中年組OSAHS患者7年隨訪睡眠呼吸暫停低通氣指數(shù)(AHI)從21.7次/h增高到30.2次/h,體重指數(shù)(BMI)、ESS評分均明顯增加,睡眠時最低血氧飽和度(L SaO2)明顯下降,7年前后比較差異均有統(tǒng)計學意義(P0.01); 老年組OSAHS患者AHI從25.6次/分增高到30.7次/分、BMI有增高趨勢、ESS評分有減輕趨勢,但7年前后差異均無統(tǒng)計學意義(P0.05);L SaO2較7年前明顯下降,差異有統(tǒng)計學意義(P0.01)。 (2)組間變化值比較: 中年組OSAHS患者的AHI隨訪7年后上升值顯著高于老年組,差異有統(tǒng)計學意義(P0.01)。中年組L SaO2隨訪7年后下降值顯著高于老年組,差異有統(tǒng)計學意義(P0.01)。 結(jié)論: 未接受治療的中年OSAHS患者隨著年齡的增長,睡眠障礙的程度逐漸加重,而未治療的老年OSAHS患者隨著病程延長,睡眠障礙進展趨勢有所減緩,但心腦血管等并發(fā)癥明顯增多。表明阻塞性睡眠呼吸暫停低通氣綜合征是一種潛在進展性疾病,應當早期治療延緩病程進展,減少并發(fā)癥的發(fā)生。
[Abstract]:Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea hypopnea syndrome, OSAHS) is a recurrent, transient, reversible upper airway stenosis or obstruction that causes apnea or hypoventilation, sometimes accompanied by snoring, and a group of symptoms that cause excessive daytime sleepiness. Snoring (snoring disease) is snoring. Snoring is a prominent symptom of obstructive sleep apnea hypopnea syndrome, which is more than 60 decibels, which hinders the passage of respiratory airflow in the upper respiratory tract and affects the rest of the same room or causes other people's troubles.
Snoring and OSAHS are common and frequently occurring diseases of the respiratory system. The prevalence of snoring is 3% to 48% in all age groups. The prevalence of OSAHS in children is 1% to 3%, and the prevalence rate of OSAHS in adults is 2% to 4%. The prevalence rate of OSAHS in the elderly is 20% to 40%. snoring and OSAHS is mainly the frequent apnea and low pass during sleep. Qi, caused by chronic intermittent hypoxia, hypercapnia, increased negative pressure of the thoracic cavity, repeated micro awakening and abnormal sleep structure, resulting in a series of clinical symptoms such as autonomic nervous dysfunction, oxidative stress and inflammation, vascular endothelial cell injury, blood flow viscosity, hypercoagulability, fibrinolysis, urogenital and endocrine and metabolic abnormalities. At present, snoring and OSAHS are considered as systemic diseases, and the independent risk factors such as cardiovascular and cerebropulmonary diseases and metabolic syndrome are gradually paid attention to, and become a hot spot of research. The snoring and OSAHS patients' sudden death in sleep are increased without treatment, but snoring and OSAHS are chronic diseases, people include A small number of medical workers lack sufficient knowledge of cardiovascular, cerebrovascular and pulmonary complications and even multiple organ damage or diseases.
He J and other untreated OSAHS patients were followed up and found that the 5 year fatality rate of the AHI20 /h was 11% to 13%, the 8 year fatality rate was 37%, and no 1 died by the airway incision and continuous positive airway pressure ventilation (CPAP), and 6 patients died through the uvulopalatopharyngoplasty (UPPP). Snoring and OSAHS seriously affected the patient's working ability. Live quality and survival rate, and cause great social financial burden.
For this purpose, this study conducted a 7 year follow-up study on snoring and OSAHS in Chengde in 2002 to investigate the effects of snoring and OSAHS on the health of the population, observe the incidence and mortality of different complications during the 7 year follow-up of snoring and non snoring people, analyze the risk factors, and compare the sleep monitoring before and after the follow-up of untreated OSAHS patients and The changes of clinical characteristics provide a theoretical basis for the prevention and treatment of the disease. This study includes two parts:
Part one: 7 year follow-up study on snoring and non snoring patients in Chengde urban area
The second part: analysis of the characteristics of sleep monitoring in patients with obstructive sleep apnea hypopnea syndrome the first part of the 7 year follow-up study of snoring and non snoring people in Chengde urban residents
Objective:
To investigate the effect of snoring on the health of the population, observe the incidence and mortality of different complications during the 7 year follow-up of snoring and non snoring people, analyze the risk factors and provide a theoretical basis for the prevention and treatment of the disease.
Method:
The subjects were 1168 snoring and OSAHS people in Chengde city in 2002. They were followed up from February 2009 to May and redesigned a questionnaire. 298 people in snoring group (including 27 deaths) and 764 non snoring groups (including 24 deaths). 144 people in non snoring group were snoring during the 7 year follow-up period (snoring). The incidence and mortality of complications during the 7 year follow-up of snoring and non snoring groups were compared. The risk factors of snoring during the 7 year follow-up of non snoring group (logistic regression analysis) were analyzed and the cognitive conditions were compared.
Result:
1. the incidence of different complications in snoring group and non snoring group during 7 years follow-up period:
During the 7 year follow-up, the incidence of hypertension in the snoring group was significantly higher than that in the non snoring group, 75.6% and 17.4%, respectively, and the two groups were statistically significant (P0.01), the incidence of coronary heart disease was 25.8% and 7.2%, the two groups were statistically significant (P0.01), and the incidence of cerebrovascular disease was 21.8% and 5.7%, respectively, and the two groups were statistically different. The incidence of diabetes mellitus (P0.01) was 19.2% and 4.2% respectively. The difference between the two groups was statistically significant (P0.01), and the incidence of chronic kidney disease was 4.1% and 0.5%, respectively, and the two groups had a significant difference (P0.01).
2. the mortality rate of snoring group and non snoring group died from various diseases:
Among the 51 people, 27 were killed in the snoring group and 24 in the non snoring group. The mortality rate of the snoring group was significantly higher than that of the non snoring group, 9.06% and 3.87% respectively. The two groups were statistically significant (P0.01). The mortality rate of the snoring and non snoring groups was 2.3% and 0.6% respectively, and the two groups were statistically different. The mortality of cerebrovascular disease was 3.7% and 1%, respectively, and the difference between the two groups was statistically significant (P0.01), the mortality of cardiovascular disease was 3% and 1.5%, respectively, and there was no significant difference between the two groups (P0.05).
The risk factors of snoring during the 7 year follow-up of 3. non snoring groups were analyzed by logistic regression analysis: the family history of snoring, smoking index, body mass index (BMI) and snoring were significantly related (P0.01), and age was associated with the occurrence of snoring (P0.05).
4. cognitive status of snoring: people think that snoring is a disease and the need for treatment in 2002 is 25.34%, 2009 is 23.44%, and the two survey results are compared, the difference is not statistically significant (P0.05).
Conclusion:
Snoring is a high risk factor for hypertension, coronary heart disease, cerebrovascular disease, diabetes, and chronic kidney disease. The mortality rate of snoring is significantly higher than that of non snoring people. Snoring family history, smoking index, body mass index, age are risk factors for snoring. People's cognition of snoring and OSAHS's disease is still not significantly improved. Therefore, Further increase the publicity.
The second part analysis of sleep monitoring characteristics in patients with obstructive sleep apnea hypopnea syndrome
Objective:
Objective to analyze the changes of sleep monitoring and clinical characteristics before and after 7 years of follow-up in OSAHS patients who had not received treatment.
Method:
The subjects were 99 patients with OSAHS in Chengde city in 2002, including 63 cases in the middle age group (45 men, 18 women), 36 cases in the elderly group (22 men and 14 women), all were not treated, and were followed up again after 7 years. The sleep breathing monitoring was performed and the changes of clinical characteristics were analyzed.
Result:
1. the changes of severity and clinical characteristics in the middle-aged group and the elderly group before and after 7 years.
The incidence of nocturnal waking of OSAHS patients in the middle age group was higher than that in the elderly group (P0.05); the incidence of daytime sleepiness in middle-aged group OSAHS patients was not statistically significant (P0.05) compared with the elderly group (P0.05); the incidence of hypertension in the elderly OSAHS patients was higher than that in the middle age group (P0.05); the coronary heart rate of the elderly patients with OSAHS was significantly higher than that in the elderly group (P0.05). The incidence of disease, cerebrovascular disease and diabetes was significantly higher than that in the middle age group (P0.01); the severity of OSAHS in the middle age group was significantly higher than that of 7 years ago, and the difference was statistically significant (P0.01); the severity of OSAHS in the elderly group was more severe than that of 7 years ago, but the difference was not statistically significant (P0.05).
2. the change of sleep monitoring index of OSAHS patients in middle age group and elderly group before and after 7 years.
(1) before and after the comparison:
The sleep apnea hypopnea index (AHI) increased from 21.7 times /h to 30.2 times in the middle age group of OSAHS patients, and the body mass index (BMI), ESS score increased significantly, and the lowest blood oxygen saturation (L SaO2) decreased significantly during sleep, and the difference was statistically significant (P0.01) before and after 7 years.
The AHI of OSAHS patients in the elderly group increased from 25.6 to 30.7 / min, BMI had a tendency to increase, and the ESS score had a decreasing trend, but there was no significant difference between 7 years and before (P0.05), and L SaO2 decreased significantly compared with 7 years ago, the difference was statistically significant (P0.01).
(2) the comparison of the change values between the groups:
The upward appreciation of AHI in middle age group OSAHS patients was significantly higher than that in the elderly group after 7 years. The difference was statistically significant (P0.01). The decline value of middle age group L SaO2 after 7 years was significantly higher than that in the elderly group, the difference was statistically significant (P0.01).
Conclusion:
Middle aged OSAHS patients with untreated age increased with age, and the degree of sleep disorders increased gradually, while the elderly OSAHS patients who were not treated prolonged with the duration of the disease, and the progression of sleep disorders slowed down, but the cardiovascular and cerebrovascular complications were significantly increased. The disease should be treated early to delay the progression of the disease and reduce the incidence of complications.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R766

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