目的 通过比较阻塞性睡眠呼吸暂停低通气综合征(OSAHS)快动眼(REM)与非快动眼(NREM)分型的多道睡眠图(PSG)分析,探讨OSHAS的发生机制.方法 采用Siddiqui方法,将137例成年OSAHS患者根据不同睡眠期的呼吸暂停低通气指数(AHI)分为REM型(REM期AHI/NREM期AHI>1)及NREM型(REM期AHI/NREM期AHI<1),比较两型间总体及各程度分组中PSG参数的差异.结果 REM型OSHAS患者72例(52.6%),NREM型65例(47.4%).REM型OSAHS患者的AHI和NREM期AHI较NREM型患者低,而最低血氧饱和度(lowest arterial oxygensaturation,LSaO_2)、REM期LSaO_2和NREM期LSaO_2均较NREM型高(t值分别为-6.466、-7.638、3.426、2.472和4.873,P值均<0.05);两型间的睡眠结构、REM期AHI的差异无统计学意义(P值均>0.05).OSAHS轻、中、重3组中,REM型的构成比呈下降趋势,分别为77.8%、61.5%、37.3%;NREM型的构成比则逐渐升高,分别为22.7%、38.5%、62.7%(x~2=16.996,P<0.01).轻度组与中度组中,NREM型OSAHS患者的REM期LSaO_2较REM型高,差异有统计学意义(t值分别为-4.273和-2.136,P值均<0.05),两型间AHI、LSaO_2、NREM期LSaO_2的差异均无统计学意义(P值均>0.05).重度组中NREM型患者的AHI高于REM型,而LSaO_2、REM期LSaO_2及NREM期LSaO_2则低于REM型,差异均有统计学意义(t值分别为-4.943、2.574、1.996和3.571,P值均≤0.05).两型OSAHS患者的睡眠潜伏期、睡眠有效率差异均无统计学意义(P值均>0.05).结论 REM型主要分布于轻、中度OSAHS,而NREM型主要分布于重度OSAHS,NREM型患者的呼吸事件发生率、缺氧情况可能更重些.发生于不同睡眠分期的呼吸暂停可能对患者的睡眠结构、睡眠效率及睡眠潜伏期影响不大.%Objective To study the value of a new measurement that divided obstructive sleep apnea-hypopnea syndrome (OSAHS) into rapid-eye-movement (REM) related and non-rapid-eye-movement (NREM) related subgroups.Methods According to Siddiqui classification, 137 adult patients with OSHAS were diagnosed as REM-related OSAHS [REM apnea hyponea index (AHI)/NREM AHI > 1] or NREM-related OSAHS (REM AHI/NREM AHI < 1).Polysonmographic data were compared and discussed.Results ①There were 72 cases defined as REM-related OSAHS (52.6％) and 65 cases defined as NREM-related OSAHS (47.4％).②In all cases, total AHI and NREM AHI in REM-related OSAHS were significantly lower than those in NREM-related OSAHS, while lowest arterial oxygen saturation (LSaO_2), REM LSaO_2 and NREM LSaO_2 were significandy higher than those in NREM-related OSAHS (t were - 6.466, - 7.638, 3.426, 2.472, 4.873 respectively, P < 0.05).No significance was found in sleep structure, REM AHI and REM LSaO_2 between REM-related and NREM-related OSAHS (P > 0.05).③Given the severity of OSHAS, the constituent ratio of REM-related OSAHS decreased (77.8％ ,61.5％, 37.3％) from mild to severe OSAHS, while that of NREM-related OSAHS rose (22.7％ ,38.5％ ,62.7％ ; X~2 = 16.996, P < 0.01). In mild and moderate groups, REM LSaO_2 of REM-related OSAHS was significantly lower than those in NREM-related OSAHS (t were -4.273 and -2.136, P < 0.05), while the differences of total AHI and LSaO_2 ,NREM LSaO_2 between these two types were not significant.In severe group, AHI in NREM-related OSAHS was significantly higher than that in REM-related OSAHS, while LSaO_2,REM LSaO_2 and NREM LSaO_2 was significantly lower than those in REM-related OASHS (t were -4.943, 2.574, 1.996, 3.571, P≤0.05).④There was no significance in sleeping latency and efficiency between REM-related and NREM-related OSHAS.Conclusions REM-related OSHAS mainly exists in mild and moderate OSHAS, while NREM-related one mainly exists in severe OSHAS.NREM-related OSAHS may be more severe in AHI and hypoxia than REM-related one.Whenever obstructive apnea happened in REM or NREM period, its impacts on sleep structure, efficiency and latency have no difference.
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