快速眼动睡眠相关阻塞性睡眠呼吸暂停病人的临床特征及其与代谢综合征的相关性研究

李子锋; 葛义俊; 姚明仁; 王幼萌; 白新苹

快速眼动睡眠相关阻塞性睡眠呼吸暂停病人的临床特征及其与代谢综合征的相关性研究

Study on the clinical characteristics of patients with rapid eye movement sleep-related obstructive sleep apnea and its correlation with metabolic syndrome

摘要

摘要:
目的： 分析不同睡眠亚型的阻塞性睡眠呼吸暂停（OSA）病人的临床特征、睡眠监测指标及其与代谢综合征（MetS）发生的相关性。
方法： 回顾性选取阜阳市人民医院神经内科收治的113例OSA病人为研究对象，根据非快速眼动睡眠（NREM）和快速眼动睡眠（REM）的呼吸暂停低通气指数（AHI），将REM期AHI值（AHI–REM）/NREM期AHI值（AHI–NREM）≥ 2 分为REM–OSA组，AHI–REM/AHI–NREM﹤2分为NREM–OSA组，比较2组一般人口学资料及睡眠监测各指标间差异，采用Spearman偏相关分析比较不同睡眠亚型OSA与MetS发生的相关性。
结果： 共纳入113例病人，其中REM–OSA组27例，NREM–OSA组86例；与NREM–OSA组比较，REM–OSA组女性占比较高，吸烟、饮酒占比、脑梗死患病率、糖化血红蛋白水平均低于NREM–OSA组（P ＜ 0.05 ~ P ＜ 0.01）；2组间睡眠检测指标比较，REM–OSA组的AHI–NREM、总AHI值、睡眠效率、觉醒时间显著低于NREM–OSA组，NREM 3期所占睡眠总时间百分比（N3%）、最低血氧饱和度（L–SaO₂）（NREM）显著高于NREM–OSA组（P ＜ 0.05 ~ P ＜ 0.01）。临床相关指标对MetS的影响的单因素分析显示，在113例全部受试者中，与非MetS病人比较，MetS病人的BMI值较高、吸烟、饮酒、有脑梗死病史及高血压占比较高；FBG、HbA1c、TG、CRP水平较高（P ＜ 0.05 ~ P ＜ 0.01）；在27例REM–OSA组中，较之于非MetS病人，MetS病人的年龄较大、高血压占比较高；空腹血糖、甘油三酯及 C反应蛋白水平较高（P ＜ 0.05 ~ P ＜ 0.01）；在86例NREM–OSA组中，较之于非MetS病人，MetS病人的的年龄较小、男性占比较高、BMI较高、吸烟、饮酒比例较大、有脑梗死病史及高血压占比较高；空腹血糖、甘油三酯及 C反应蛋白水平较高（P ＜ 0.05 ~ P ＜ 0.01）。睡眠指标对MetS影响的单因素分析显示，在全部受试者及NREM–OSA组中，与非MetS病人比较，MetS病人总睡眠时间减少，差异均有统计学意义（P ＜ 0.05）；但在REM–OSA组中MetS病人与非MetS病人总睡眠时间相近，AHI–NREM及L–SaO₂（REM）却呈现显著性差异，具有统计学意义（P ＜ 0.01和P ＜ 0.05）。Spearman相关分析结果显示，在全部受试者及NREM–OSA组中，总睡眠时间和MetS患病呈显著负相关，而L–SaO₂（REM）和MetS患病呈显著正相关（ P ＜ 0.05）。在REM–OSA组中，总睡眠时间、睡眠潜伏期、REM潜伏期、NREM 3期所占睡眠总时间百分比及AHI–REM/AHI–NREM指标，和MetS患病呈显著负相关，而睡眠效率、NREM 2期所占睡眠总时间百分比指标和MetS患病呈显著正相关（P ＜ 0.05）。
结论： REM–OSA与NREM–OSA病人在人群特征、共病模式、睡眠结构及与MetS的关联方面均有显著不同，这为OSA的个体化评估与MetS风险分层提供了临床参考。

Abstract:
Objective To analyze the clinical characteristics, sleep monitoring parameters, and their correlation with the occurrence of metabolic syndrome (MetS) in obstructive sleep apnea (OSA) patients with different sleep subtypes.
Methods A retrospective study was conducted on 113 OSA patients admitted to the Department of Neurology, Fuyang People's Hospital. Based on the apnea-hypopnea index (AHI) in the non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, the patients were divided into the REM-OSA group (AHI-REM/AHI-NREM ≥ 2) and NREM-OSA group (AHI-REM/AHI-NREM ＜ 2). The general demographic data and polysomnographic parameters were compared between two groups. Spearman's partial correlation analysis was used to analyze the correlation between different OSA sleep subtypes and occurrence of MetS.
Results A total of 113 patients were included, among which 27 cases were in the REM-OSA group and 86 cases were in the NREM-OSA group. Compared with the NREM-OSA group, the proportion of females was higher in the REM-OSA group. The proportions of smoking and drinking, prevalence of cerebral infarction and level of glycated hemoglob in the REM-OSA group were all lower than those in the NREM-OSA group (P ＜ 0.05 to P ＜ 0.01). Comparison of sleep detection indicators between the two groups: The AHI-NREM, total AHI value, sleep efficiency and awakening time in the REM-OSA group were significantly lower than those in the NREM-OSA group. The percentage of total sleep time in NREM stage 3 (N3%) and lowest blood oxygen saturation (L-SaO2) (NREM) were significantly higher than those in the NREM-OSA group (P ＜ 0.05 to P ＜ 0.01). The univariate analysis of the impact of clinically relevant indicators on MetS showed that among all 113 subjects, compared with non-mets patients, MetS patients had a higher BMI value, a higher proportion of smoking, drinking, a history of cerebral infarction and hypertension. The levels of FBG, HbA1c, TG and CRP were relatively high (P ＜ 0.05 to P ＜ 0.01). Among the 27 cases in the REM-OSA group, compared with non-MetS patients, MetS patients were older, and had a higher proportion of hypertension. The levels of fasting blood glucose, triglycerides and C-reactive protein were relatively high (P ＜ 0.05 to P ＜ 0.01). Among the 86 cases in the NREM-OSA group, compared with the non-MetS patients, the MetS patients were younger, had a higher proportion of males, a higher BMI, a greater proportion of smokers and drinkers, and a higher proportion of patients with a history of cerebral infarction and hypertension. The levels of fasting blood glucose, triglycerides and C-reactive protein were relatively high (P ＜ 0.05 to P ＜ 0.01). Univariate analysis of the influence of sleep indicators on MetS showed that in all subjects and the NREM-OSA group, compared with non-MetS patients, the total sleep time of MetS patients decreased, and the differences were statistically significant (P ＜ 0.05). However, in the REM-OSA group, the total sleep time of MetS patients was similar to that of non-mets patients, but there were significant differences in AHI-NREM and L-SaO2 (REM), which were statistically significant (P ＜ 0.01 and P ＜ 0.05). The results of Spearman correlation analysis showed that in all subjects and the NREM-OSA group, the total sleep time was significantly negatively correlated with the prevalence of MetS, while the L-SaO2 (REM) was significantly positively correlated with the prevalence of MetS (P ＜ 0.05). In the REM-OSA group, the total sleep time, sleep latency, REM latency, percentage of total sleep time in NREM stage 3 and AHI-REM/AHI-NREM index were significantly negatively correlated with the prevalence of MetS. However, the indicators of sleep efficiency and percentage of total sleep time in NREM stage 2 were significantly positively correlated with the prevalence of MetS (P ＜ 0.05).
Conclusions There are significant differences between REM-OSA and NREM-OSA patients in terms of population characteristics, comorbidity patterns, sleep structure and association with MetS, which can provide the clinical references for individualized assessment of OSA and risk stratification of MetS.

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