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阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的发病机制是上呼吸道阻塞或塌陷而导致的机体在睡眠时间歇性缺氧,从而引起全身的氧化应激反应,可造成多个器官的慢性损伤。其中肥胖是其主要的危险因素,40~70岁肥胖者OSAS发病可达20% ~40%[1-2]。功能性便秘(functional constipation,FC)是功能性胃肠疾病的一种,表现为持续的排便困难、排便次数减少或排便不尽感,且不符合肠易激综合征(irritable bowel syndrome, IBS)的诊断标准。FC的发病机制目前尚未完全阐明,但研究认为肥胖与功能性胃肠疾病关系密切[3-4]。那么,FC和OSAS两种疾病间有无关联, 机制如何, 目前相关研究还很少。故本文就OSAS和FC的相关性进行了研究,并探讨其相关机制。
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观察组病人AHI及BMI评分明显高于对照组病人(P < 0.01)(见表 1)。
分组 n AHI评分/分 BMI/(kg/m2) 观察组 82 56.9±17.34 36.5±5.2 对照组 103 32.3±11.09 25.3±4.6 t — 11.16* 15.52 P — < 0.01 < 0.01 *示t′值 表 1 2组OSAS严重程度及肥胖程度比较(x±s)
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4组病人AHI、ODI、minSaO2%、Ts90、AD比较,差异均有统计学意义(P < 0.01)。重度FC+OSAS组病人的AHI、ODI、Ts90,中重度FC+OSAS组病人的AD均较对照组显著增高(P < 0.01),minSaO2%则较对照组显著降低(P < 0.01),轻中度FC+OSAS组病人的AHI、ODI、Ts90,轻度FC+OSAS组病人的AD均较对照组有所降低(P < 0.05~P < 0.01);轻中度FC+OSAS组病人的AHI、ODI、Ts90、AD均较重度组显著降低(P < 0.01),轻度FC+OSAS组病人的minSaO2%则较重度组有所增高(P < 0.05);轻度FC+OSAS病人的AHI、ODI、AD均较中度组有所降低(P < 0.05~P < 0.01)(见表 2)。
分组 n AHI ODI minSaO2% Ts90% AD/s 轻度FC+OSAS 23 9.5±2.6**##△△ 9.1±3.4**##△ 83.6±6.1# 1.5±1.1**## 30.3±8.5**##△△ 中度FC+OSAS 18 23.6±3.9*## 23.7±5.8**## 81.5±5.8 6.3±2.4## 47.4±14.2## 重度FC+OSAS 41 58.3±22.7** 46.3±7.2** 74.8±11.4** 22.7±20.3** 67.1±23.7** 对照组OSAS 103 32.3±11.09 38.1±25.6 86.9±13.5 12.7±17.5 40.9±12.5 F — 72.32 142.50 10.44 9.73 37.01 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 185.435 385.340 139.107 264.341 239.903 q检验:与对照组比较*P < 0.05,**P < 0.01;与中度FC+OSAS比较△P < 0.05,△△P < 0.01;与重度FC+OSAS比较#P < 0.05,##P < 0.01 表 2 OSAS并不同程度FC病人各睡眠参数比较(x±s)
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4组病人睡眠1+2期比例、慢波睡眠比例、睡眠REM期比例、呼吸相关微觉醒指数比较,差异均有统计学意义(P < 0.01)。中重度FC+OSAS组睡眠1+2期比例、呼吸相关微觉醒指数较对照组有所增加(P < 0.05~P < 0.01);重度FC+OSAS组慢波睡眠比例、中重度FC+OSAS组睡眠REM期比例均较对照组显著降低(P < 0.01);轻度FC+OSAS组睡眠1+2期比例、呼吸相关微觉醒指数较重度组有所降低(P < 0.05~P < 0.01),慢波睡眠比例、睡眠REM期比例则较重度组有所增高(P < 0.05~P < 0.01);轻度FC+OSAS组睡眠1+2期比例较中度组有所降低,睡眠REM期比例则较中度组有所增加(P < 0.05)(见表 3)。
分组 n 睡眠1+2期比例/% 慢波睡眠比例/% 睡眠REM期比例/% 呼吸相关微觉醒指数/(次/小时) 轻度FC+OSAS 23 69.3±9.7##△ 13.4±10.3# 15.7±5.3##△ 17.9±15.2## 中度FC+OSAS 18 79.6±11.7** 8.2±7.3## 9.6±2.5** 30.1±10.4* 重度FC+OSAS 41 82.3±6.7** 6.1±5.2** 8.7±1.8** 35.3±17.6** 对照组OSAS 103 70.4±12.1 14.7±13.5 15.2±8.7 19.1±18.4 F — 14.92 6.54 11.39 10.32 P — < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 116.721 126.580 47.371 297.487 q检验:与对照组比较*P < 0.05,**P < 0.01;与中度FC+OSAS比较△P < 0.05;与重度FC+OSAS比较##P < 0.01 表 3 OSA并不同程度FC病人睡眠结构比较(x±s)
阻塞性睡眠呼吸暂停综合征并功能性便秘的相关性研究
Study on the correlation of obstructive sleep apnea syndrome with functional constipation
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摘要:
目的对阻塞性睡眠呼吸暂停综合征(OSAS)并功能性便秘(FC)的相关性进行分析研究。 方法选取OSAS病人185例作为研究对象,按照是否合并FC分为观察组(n=82)和对照组(n=103)。统计并比较2组病人的睡眠呼吸暂停低通气指数(AHI)、睡眠参数、睡眠结构和体质量指数(BMI)。 结果观察组AHI、BMI值均显著高于对照组(56.9±17.34)vs(32.3±11.09)(P < 0.01)。中重度FC+OSAS组病人的AD均较对照组显著增高(P < 0.01),minSaO2%则较对照组显著降低(P < 0.01)。中度FC+OSAS组病人睡眠1+2期比例、呼吸相关微觉醒指数分别为(79.6±11.7)(30.1±10.4),均显著高于对照组(P < 0.01)。重度FC+OSAS组病人睡眠1+2期比例、呼吸相关微觉醒指数分别为(82.3±6.7)(35.3±17.6),均显著高于对照组(P < 0.01)。中度FC+OSAS组病人慢波睡眠比例、睡眠REM期比例值分别为(8.2±7.3)(9.6±2.5),重度FC+OSAS组病人慢波睡眠比例、睡眠REM期比例值分别为(6.1±5.2)(8.7±1.8),均显著低于对照组(P < 0.01)。 结论FC和OSAS密切相关。 -
关键词:
- 阻塞性睡眠呼吸暂停综合征 /
- 便秘 /
- 睡眠呼吸暂停低通气指数 /
- 睡眠结构
Abstract:ObjectiveTo investigate the correlation between obstructive sleep apnea syndrome(OSAS) and functional constipation(FC). MethodsOne hundred and eighty-five patients with OSAS were divided into the observation group(82 OSAS cases complicated with FC) and control group(103 cases).The apnea-hypopnea index(AHI), sleep parameters, sleep structure and body mass index(BMI) were comapred between two groups. ResultsThe AHI and BMI values in observation group were significantly higher than those in control group[(56.9±17.34) vs(32.3±11.09)](P < 0.01).The AD in moderate and severe FC+OSAS group was significantly higher than that in control group (P < 0.01), while minSaO2% was significantly lower than that in control group (P < 0.01).In the moderate(FC+OSAS) group, the proportion of sleep stage 1+2 and respiration-related microarousal index were(79.6±11.7) and (30.1±10.4), respectively, which were significantly higher than those in control group(P < 0.01).In the severe(FC+OSAS) group, the proportion of sleep stage 1+2 and respiration related microarousal index were(82.3±6.7) and (35.3±17.6), respectively, which were significantly higher than those in control group(P < 0.01).The proportions of slow-wave sleep and REM sleep in the moderate and severe (FC+OSAS) groups were[(8.2±7.3) and(9.6±2.5)] and[(6.1±5.2) and(8.7±1.8)], respectively, and which were significantly lower than those in control group(P < 0.01). ConclusionsFC is closely related to OSAS. -
Key words:
- obstructive sleep apnea syndrome /
- constipation /
- apnea-hypopnea index /
- sleep structure
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表 1 2组OSAS严重程度及肥胖程度比较(x±s)
分组 n AHI评分/分 BMI/(kg/m2) 观察组 82 56.9±17.34 36.5±5.2 对照组 103 32.3±11.09 25.3±4.6 t — 11.16* 15.52 P — < 0.01 < 0.01 *示t′值 表 2 OSAS并不同程度FC病人各睡眠参数比较(x±s)
分组 n AHI ODI minSaO2% Ts90% AD/s 轻度FC+OSAS 23 9.5±2.6**##△△ 9.1±3.4**##△ 83.6±6.1# 1.5±1.1**## 30.3±8.5**##△△ 中度FC+OSAS 18 23.6±3.9*## 23.7±5.8**## 81.5±5.8 6.3±2.4## 47.4±14.2## 重度FC+OSAS 41 58.3±22.7** 46.3±7.2** 74.8±11.4** 22.7±20.3** 67.1±23.7** 对照组OSAS 103 32.3±11.09 38.1±25.6 86.9±13.5 12.7±17.5 40.9±12.5 F — 72.32 142.50 10.44 9.73 37.01 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 185.435 385.340 139.107 264.341 239.903 q检验:与对照组比较*P < 0.05,**P < 0.01;与中度FC+OSAS比较△P < 0.05,△△P < 0.01;与重度FC+OSAS比较#P < 0.05,##P < 0.01 表 3 OSA并不同程度FC病人睡眠结构比较(x±s)
分组 n 睡眠1+2期比例/% 慢波睡眠比例/% 睡眠REM期比例/% 呼吸相关微觉醒指数/(次/小时) 轻度FC+OSAS 23 69.3±9.7##△ 13.4±10.3# 15.7±5.3##△ 17.9±15.2## 中度FC+OSAS 18 79.6±11.7** 8.2±7.3## 9.6±2.5** 30.1±10.4* 重度FC+OSAS 41 82.3±6.7** 6.1±5.2** 8.7±1.8** 35.3±17.6** 对照组OSAS 103 70.4±12.1 14.7±13.5 15.2±8.7 19.1±18.4 F — 14.92 6.54 11.39 10.32 P — < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 116.721 126.580 47.371 297.487 q检验:与对照组比较*P < 0.05,**P < 0.01;与中度FC+OSAS比较△P < 0.05;与重度FC+OSAS比较##P < 0.01 -
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