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目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠脑电觉醒相关参数对白天过度嗜睡的影响.方法 顺序收集2012年6月至2013年9月广州医科大学附属第一医院收治的行多导睡眠监测(PSG)的患者205例,根据呼吸暂停低通气指数(AHI)≥5次/h诊断为OSAS和非OSAS;其中OSAS患者171例,男147例,女24例,平均年龄(46±11)岁,按照Epworth嗜睡量表(Epworth sleeping scale,ESS)将＜9分和≥9分的OSAS患者分为OSAS无白天嗜睡组(86例)和OSAS白天嗜睡组(85例).34名无白天嗜睡的非OSAS患者为对照组,其中男24名,女10名,平均年龄(40±13)岁.采用SPSS 18.0统计学软件比较3组一般资料和夜间PSG相关参数并进行分析,计量资料符合正态分布的采用x±s表示,使用单因素方差分析比较,运用Pearson法进行相关性分析;不符合正态分布的采用中位数(四分位间距)表示,使用多个独立样本的非参数检验,用Spearman法进行相关分析.结果 OSAS嗜睡组、OSAS非嗜睡组、正常对照组3组之间比较,除了快动眼睡眠期占睡眠时间％(REM％)外[(15±5)％、(16±6)％、(17±7)％,P＞0.05],年龄、体重指数、ESS评分、N1+N2％、N3％、AHI、氧减指数、平均血氧饱和度、最低血氧饱和度、SaO2低于90％的时间占睡眠时间百分比、总的脑电醒觉反应指数(A RtotI)、呼吸相关性脑电醒觉反应指数/ARtotI (RAI/ARtotI)、自发性脑电醒觉反应指数/ARtotI (SAI/ARtotI)和睡眠压力分数(SPS)差异均有统计学意义(均P＜0.05).OSAS嗜睡组和OSAS非嗜睡组比较,年龄和体重指数的差异无统计学意义(P ＞0.016 7),其余参数两两比较差异均有统计学意义(P＜0.016 7),ARtotI、SPS均与ESS呈正相关(r值分别为0.383和0.244,均P＜0.001).logistic回归分析显示仅ARtotI和SPS为OSAS的危险因素,OR值分别为1.070(95％ CI为1.038 ～1.102)和0.158(95％ CI为0.026 ～0.984).结论 OSAS白天过度嗜睡与脑电觉醒密切相关,ARtotI和SPS可作为评价OSAS患者白天过度嗜睡的客观指标.

Objective To explore the effect of arousal parameters on excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS).Methods A total of 205 patients who underwent polysomnography (PSG) from June 2012 to September 2013 in our hospital were enrolled.They were divided into 3 groups:85 patients in the OSAS sleepiness group (AHI≥5/h,ESS≥9),86 patients in the OSAS non-sleepiness group (AHI ≥ 5/h,ESS ＜ 9),and 34 healthy subjects in the control group (AHI ＜ 5 times/h,ESS ＜ 9).Patient characteristics and PSG parameters of the 3 groups were analyzed.Results The difference of age,BMI,ESS,N1 + N2％,N3％,AHI,oxygen desaturation index (ODI),mean oxygen saturation (MSaO2),lowest oxygen saturation (LSaO2),oxygen below 90％ of the time (T90％),total arousal index (ARtotI),respiratory arousal index/ARtotI (RAI/ARtotI),spontaneous arousal index/ARtotI (SAI/ARtotI),sleep pressure score (SPS) were statistically different among the 3 groups(P＜0.05).But except for REM％ [(15 ±5)％,(16 ±6)％,(17 ±7)％,P ＞0.05],the difference of age and BMI between OSAS sleepiness group and OSAS non-sleepiness group were not significant(P ＞ 0.016 7),but the difference of other indices between any 2 groups were significant (P ＜ 0.016 7).ARtotI and SPS were positively correlated with ESS (r =0.383 and 0.244,P ＜ 0.001).Logistic regression analysis showed that only awakening and SPS were the risk factors for OSAS [OR =1.070 (95％ CI:1.038-1.102) and 0.158 (95％ CI:0.026-0.984),respeetively].Conclusions Arousal at night is closely associated with EDS in OSAS.ARtotI and SPS can be evaluated as an objective indicator of EDS in OSAS patients.