不同性别的OSAHS患者临床特性的研究

摘    要：

目的:探讨OSAHS患者临床特征的性别差异。方法:4499例OSAHS患者经PSG监测和Epworth嗜睡量表(ESS)测评,按OSAHS严重程度分为轻、中、重度3组,对男、女性患者的结果进行比较,并行亚组分析。结果:女性OSAHS患者ESS评分[中位数(四分位间距)]8.0(4.0,13.0)低于男性10.0(5.0,15.0),差异有统计学意义(P<0.05),中、重度组男女性患者ESS评分差异均有统计学意义(P<0.05);女性AHI为22.8(11.6,43.1),明显低于男性35.7(16.5,61.3);女性患者较男性年龄大,颈围小,BMI小,LSaO2更高(P<0.05),且上述差异在重度组中最为明显(P<0.05);男女性患者在OSAHS轻、中、重度组中分布比例均有差异。结论:男女性患者的发病年龄、日间嗜睡程度、颈围、BMI、LSaO2、睡眠时间及OSAHS严重程度均有不同,提示OSAHS发病具有性别差异,临床上应更重视女性的不典型症状,从而积极干预,改善其预后。

关键词：

睡眠呼吸暂停低通气综合征,阻塞性 ESS量表 性别差异

Clinical characteristics of obstructive sleep apnea hypopnea syndrome in different genders

YU Leilei ZHANG Rong LI Jinrang

Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital;

Abstract：

Objective: To explore the gender difference of clinical features in patients with obstructive sleep apnea hypopnea syndrome(OSAHS), and explore the relationship between OSAHS and gender. Methods: 4499 patients with OSAHS were examined by polysomnography(PSG) and Epworth sleepiness scale(ESS). Subjects were divided into mild, moderate and severe groups according to the severity of OSAHS. The results were compared and analyzed between male and female patients. Results: The ESS score of female patients was lower than that of male, and difference was still significant in moderate and severe subgroups[8.0(4.0, 13.0) vs 10.0(5.0, 15.0), P<0.05]. The apnea hypopnea index(AHI) of female patients was significantly lower than that of male patients[22.8(11.6, 43.1) vs 35.7(16.5, 61.3), P<0.05]. Compared with male patients, female patients had older age, smaller neck circumference, smaller body mass index(BMI) and higher lowest oxygen saturation(LSaO2), and the difference mentioned above was most significant in severe subgroup(P<0.05). Difference was also found in the distribution of severity between male and female patients. Conclusion: The age of onset, daytime sleepiness, neck circumference, BMI index, lowest blood oxygen saturation, sleep time and OSAHS severity are different between male and female, suggesting that there are gender differences in OSAHS patients. Therefore, in clinical diagnosis and treatment of female patients, more attention should be paid to atypical symptoms, and the ESS scale should be modified to improve the diagnostic sensitivity of female OSAHS patients, to actively intervene and improve their prognosis.

Keyword：

sleep apnea hypopnea syndrome,obstructive; Epworth sleepiness scale; gender difference;

OSAHS是一种常见的睡眠呼吸障碍性疾病,在30～70岁人群中的患病率超过1/4,且呈逐年上升趋势[1]。研究证实,OSAHS是发生冠心病、高血压、充血性心力衰竭、心律失常等多种心血管疾病和代谢性疾病的独立危险因素,常引起生存质量下降并导致严重后果[2-3]。

OSAHS早期被描述为一种主要发生在男性人群的疾病,然而,自从1993年发表了第1项包括女性在内的研究以来,对女性OSAHS的关注度大大增加[4]。Unruh等[5]对5407名社区成人(女性占52%)进行了无人值守家庭PSG监测和睡眠问卷调查,发现客观睡眠质量参数中,女性睡眠总时间和睡眠潜伏期较男性更长,慢波睡眠更少;而主观睡眠质量方面,女性的主观睡眠质量却随着年龄的增长而下降,而男性的主观睡眠质量与年龄却没有实质性联系。Nigro等[6]发现,与男性相比,女性OSAHS患者更容易主诉疲倦、失眠和早晨头痛,而典型的打鼾、呼吸暂停症状较少见。上述研究提示OSAHS发病可能存在性别差异,国内开展了相关研究,但均为小样本量研究[7-10]。本研究通过大样本量探索OSAHS成年患者临床特性的性别差异,从而了解OSAHS发病与性别的关系。

1 资料与方法

1.1 临床资料

本研究回顾性分析2010年1月—2020年1月因打鼾在我中心行PSG监测的4605例患者资料,其中4499例符合纳入和排除标准。4499例患者中,男3945例,女554例,男女比例为7.1∶1。男性平均年龄为(44.9±12.1)岁,颈围为(41.7±3.1)cm,BMI为28.3±3.8;女性平均年龄为(54.6±11.5)岁,颈围为(36.7±3.3)cm,BMI为27.4±4.6。纳入标准:①年龄18～80岁,性别不限;②符合OSAHS诊治指南诊断标准(2011年修订版)[11];③既往未行PSG监测且无OSAHS相关治疗史;④认知功能正常,有自主行为能力,能准确回答问卷。排除标准:①快速动眼行为障碍、发作性睡病;②严重心血管系统及呼吸系统疾病、甲状腺疾病及近期上呼吸道感染病史;③近3个月工作、作息不规律;④近期服用过苯二氮卓、巴比妥或其他镇静催眠类药物;⑤睡眠监测总时间<4 h。

1.2 方法

1.2.1 一般资料

通过问卷统计患者基本资料,包括患者的年龄、性别、职业、身高、体重、颈围及既往史。

1.2.2 嗜睡程度的主观评价

采用Epworth嗜睡量表(ESS)[11]评分,评估患者在下述8种情况中睡着的可能性:①坐着阅读时;②看电视时;③在公共场合坐着不活动(看电影或开会);④乘小汽车1 h不休息;⑤情况允许时,下午躺下休息;⑥坐着与人交谈;⑦午餐后安静地坐着(午餐未喝酒);⑧堵车时停车数分钟。按4个等级对上述情况打分(0分:从不,1分:很少可能,2分:有时可能,3分:非常可能),总分24分[12]。受试者在PSG监测前,由专业人员指导下根据自身情况填写量表,研究者最后汇总计算得分,ESS得分≥9分者认为存在白天嗜睡。

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