葡萄籽原花青素辅助治疗对中度OSAHS患者睡眠质量的影响及其机制

摘要

目的 探讨葡萄籽原花青素(简称原青花素)辅助治疗对中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠质量的影响及其机制.方法 将101例中度OSAHS患者随机分为原青花素低剂量组34例、原青花素高剂量组33例和对照组34例.三组均给予持续正压通气治疗,原青花素低剂量组和原青花素高剂量组在此基础上分别口服原青花素1、2粒/次,2次/d;疗程均为8周.三组治疗前后进行多导睡眠监测,记录最长呼吸低通气时间(MHT)、低通气指数(HI)、最长呼吸暂停时间(LAT)、呼吸暂停指数(AI)、呼吸紊乱指数(RDI)、最低血氧饱和度(LSaO2)、快速动眼期比率(REM)、微觉醒指数(M-AI),采用Epworth嗜睡量表(简称嗜睡量表)对主观嗜睡程度进行评分.采用双抗体夹心酶标免疫分析法检测三组治疗前后血清丙二醛(MDA)、超氧化物歧化酶(SOD)水平.结果 与治疗前比较,三组治疗后MHT、HI、LAT、AI、RDI、M-AI、嗜睡量表评分和血清MDA水平均降低,LSaO2、REM和血清SOD水平均升高(P均＜0.05).与对照组治疗后比较,原青花素低剂量组和高剂量组MHT、HI、RDI、M-AI、嗜睡量表评分和血清MDA水平均降低,LSaO2、REM均升高,但原青花素高剂量组变化更明显(P均＜0.05).三组治疗后LAT、AI、血清SOD水平比较差异均无统计学意义(P均＞0.05).结论 原青花素辅助治疗可改善中度OSAHS患者的睡眠结构,提高其睡眠质量,高剂量效果更好;降低患者体内氧化应激反应可能是其作用机制.%Objective To investigate the effect of grape seed proanthocyanidin extract (GSPE) adjuvant therapy on sleep quality of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its mechanism.Methods Totally 101 OSAHS patients were randomly divided into low-dose GSPE group (34 cases),high-dose GSPE group (33 cases) and control group (34 cases).The control group was treated with continuous positive airway pressure ventilation.Patients in the low-dose and high-dose groups were given orally GSPE 1 and 2 seeds/time,twice a day,and for 8 weeks.All subjects in the three groups received polysomnography before and after treatment.We recorded the longest time breathing low ventilation (MHT),hypopnea index (HI),the longest apnea time (LAT),apnea index (AⅠ),respiratory disturbance index (RDI),the lowest oxygen saturation (LSaO2),rapid eye movement (REM),and micro-awakening index (M-AI).The degree of subjective sleepiness was scored by Epworth Sleepiness Scale (ESS).The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in serum were measured by enzyme-linked immunosorbent assay (ELISA) before and after treatment.Results The levels of MHT,HI,LAT,AI,RDI,M-AI,ESS and serum MDA were decreased in the three groups after treatment,the levels of LSaO2,REM and serum SOD were increased in the three groups after treatment as compared with those before treatment (all P ＜ 0.05).Compared with the control group,the levels of MHT,HI,RDI,MAI,ESS and serum MDA in low-dose GSPE group and high-dose GSPE group were decreased after treatment,the levels of LSaO2 and REM were increased after treatment,and the changes were more significant in the high-dose GSPE group (all P ＜ 0.05).There was no significant difference in LAT,AI and serum SOD between the three groups after treatment (all P ＞0.05).Conclusions GSPE adjuvant treatment can improve the sleep structure and sleep quality of OSAHS patients,and the mechanism may be the reduction of oxidative stress reaction.