经颅多普勒超声对阻塞性睡眠呼吸暂停低通气综合征脑血管反应性的评价
|
摘要
目的探讨经颅多普勒超声(TCD)评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑血管反应性(CVR)的应用价值。方法选取2015年8月～2016年12月在北京市海淀医院神经内科门诊和病房治疗的OSAHS患者60例作为病例组,又根据呼吸暂停低通气指数(AHI)将患者分为轻度组15例、中度组27例及重度组18例,同期选取20例在本院健康体检者作为对照组。入选者均在入院当日接受TCD检查,检测CVR情况,包括平静呼吸时、屏气后大脑中动脉的平均血流速度(Vm),计算屏气指数(BHI),采用Pearson线性相关分析。结果病例组与对照组平静呼吸时Vm比较,差异无统计学意义[(73.64±9.87)cm/s vs (72.79±8.68)cm/s,P>0.05],病例组屏气后Vm和BHI均低于对照组,差异有统计学意义[(88.63±6.65)cm/s vs (93.26±7.12)cm/s,P<0.05;0.71±0.16 vs 0.93±0.37,P<0.01]。轻度组、中度组和重度组平静呼吸时Vm比较,差异无统计学意义(P>0.05)。轻度组屏气后Vm、BHI均高于中度组和重度组,且中度组高于重度组,差异有统计学意义(P<0.01)。AHI与平静呼吸时Vm无明显相关性(r=0.197,P=0.052),AHI与屏气后Vm和BHI呈负相关(r=-0.557,P=0.011;r=-0.605,P=0.000)。结论 TCD能反映OSAHS患者CVR的变化情况,患者屏气后Vm、BHI明显下降,病情越严重,下降越明显。
Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity(CVR)in obstructive sleep apneahypopnea syndrome(OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015 to December 2016 served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20 healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI)was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis.Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87 cm/s vs 72.79±8.68 cm/s,P>0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65 cm/s vs 93.26±7.12 cm/s,0.71±0.16 vs 0.93±0.37,P<0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P<0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHIwas negatively correlated with Vm after breath holding and BHI(r=-0.557,P=0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.
Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity(CVR)in obstructive sleep apneahypopnea syndrome(OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015 to December 2016 served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20 healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI)was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis.Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87 cm/s vs 72.79±8.68 cm/s,P>0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65 cm/s vs 93.26±7.12 cm/s,0.71±0.16 vs 0.93±0.37,P<0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P<0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHIwas negatively correlated with Vm after breath holding and BHI(r=-0.557,P=0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.
引文
[1]Hernández Voth A,SayasCatalán J,Benavides Ma1as P,et al.Obstructive sleep apnea-hypopnea syndrome in patients with severe chronic respiratory insufficiency[J].Med Clin(Barc),2017,148(10):449-452.DOI:10.1016/j.medcli.2016.12.043.
[2]Shi L,Wang H,Wei L,et al.Pharyngeal constrictor muscle fatty change may contribute to obstructive sleep apneahypopnea syndrome:aprospective observational study[J].Acta Otolaryngol,2016,136(12):1285-1290.DOI:10.1080/00016489.2016.1205220.
[3]Agha B,Johal A.Facial phenotype in obstructive sleep apnea-hypopnea syndrome:a systematic review and meta-analysis[J].J Sleep Res,2016,26(2):122-131.DOI:10.1111/jsr.12485.
[4]Aynaci E,Karaman M,Kersin B,et al.Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment[J].Acta Otolaryngol,2018,138(5):502-506.DOI:10.1080/00016489.2017.1417635.
[5]Minhas JS,Syed NF,Haunton VJ,et al.Is dynamic cerebral autoregulation measurement using transcranial Doppler ultrasound reproducible in the presence of high concentration oxygen and carbon dioxide[J]?Physiol Meas,2016,37(5):673-682.DOI:10.1088/0967-3334/37/5/673.
[6]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.
[7]Akgün H,Tasdemir S,Ulas UH,et al.Reduced breath holding index in patients with chronic migraine[J].Acta Neurol Belg,2015,115(3):323-327.DOI:10.1007/s13760-014-0375-y.
[8]中华耳鼻咽喉头颈外科杂志编辑委员会中华医学会耳鼻咽喉头颈外科学分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):95-96.DOI:10.3760/cma.j.issn.1673-0860.2009.02.002.
[9]Abad J,Mu1oz-Ferrer A,Cervantes M,et al.Automatic video analysis for obstructive sleep apnea syndrome diagnosis[J].Sleep,2016,39(8):1507-1515.DOI:10.5665/sleep.6008.
[10]Kayhan FT,Kaya KH,Koa AK,et al.Multilevel combined surgery with transoral robotic surgery for obstructive sleep apnea syndrome[J].J Craniofac Surg,2016,27(4):1044-1048.DOI:10.1097/scs.0000000000002608.
[11]Serra-Torres S,Bellot-Arcís C,Montiel-Company JM,et al.Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome:a systematic review[J].Laryngoscope,2016,126(2):507-514.DOI:10.1002/lary.25505.
[12]Nikolopoulou M,Byraki A,Ahlberg J,et al.Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome:a randomized,placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems[J].J Oral Rehabil,2017,44(6):452-460.DOI:10.1111/joor.12505.
[13]宋学萍,于士龙,杨惠娟,等.应用经颅多普勒超声评价OSAHS患者脑血流储备的变化及其与突发性脑血管事件的关系[J].中华神经医学杂志,2015,14(5):493-496.DOI:10.3760/cma.j.issn.1671-8925.2015.05.013.
[14]Sam K,Peltenburg B,Conklin J,et al.Cerebrovascular reactivity and white matter integrity[J].Neurology,2016,87(22):2333-2339.DOI:10.1212/WNL.0000000000003373.
[15]Hegedu2I,Mili'c J,'Cosi'c A,et al.Cerebrovascular reactivity in acute hyperoxia in patients with acute ischaemic stroke[J].Brain Inj,2017,31(4):560-566.DOI:10.1080/02699052.2017.1280853.
[16]Cardim D,Schmidt B,Robba C,et al.Transcranial Doppler monitoring of intracranial pressure plateau waves[J].Neurocrit Care,2017,26(3):330-338.DOI:10.1007/s12028-016-0356-5.
[17]Hernández Voth A,Sayas Catalán J,Benavides Ma1as P,et al.Obstructive sleep apnea-hypopnea syndrome in patients with severe chronic respiratory insufficiency[J].Med Clin(Barc),2017,148(10):449-452.DOI:10.1016/j.medcli.2016.12.043.
[18]Afonso Delgado L,Micoulaud Franchi JA,Monteyrol PJ,et al.Implantable nerve stimulation for obstructive sleep apnea hypopnea syndrome[J].Presse Med,2016,45(2):183-192.DOI:10.1016/j.lpm.2015.11.008.
[2]Shi L,Wang H,Wei L,et al.Pharyngeal constrictor muscle fatty change may contribute to obstructive sleep apneahypopnea syndrome:aprospective observational study[J].Acta Otolaryngol,2016,136(12):1285-1290.DOI:10.1080/00016489.2016.1205220.
[3]Agha B,Johal A.Facial phenotype in obstructive sleep apnea-hypopnea syndrome:a systematic review and meta-analysis[J].J Sleep Res,2016,26(2):122-131.DOI:10.1111/jsr.12485.
[4]Aynaci E,Karaman M,Kersin B,et al.Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment[J].Acta Otolaryngol,2018,138(5):502-506.DOI:10.1080/00016489.2017.1417635.
[5]Minhas JS,Syed NF,Haunton VJ,et al.Is dynamic cerebral autoregulation measurement using transcranial Doppler ultrasound reproducible in the presence of high concentration oxygen and carbon dioxide[J]?Physiol Meas,2016,37(5):673-682.DOI:10.1088/0967-3334/37/5/673.
[6]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.DOI:10.3760/cma.j.issn.1001-0939.2012.01.007.
[7]Akgün H,Tasdemir S,Ulas UH,et al.Reduced breath holding index in patients with chronic migraine[J].Acta Neurol Belg,2015,115(3):323-327.DOI:10.1007/s13760-014-0375-y.
[8]中华耳鼻咽喉头颈外科杂志编辑委员会中华医学会耳鼻咽喉头颈外科学分会咽喉学组.阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):95-96.DOI:10.3760/cma.j.issn.1673-0860.2009.02.002.
[9]Abad J,Mu1oz-Ferrer A,Cervantes M,et al.Automatic video analysis for obstructive sleep apnea syndrome diagnosis[J].Sleep,2016,39(8):1507-1515.DOI:10.5665/sleep.6008.
[10]Kayhan FT,Kaya KH,Koa AK,et al.Multilevel combined surgery with transoral robotic surgery for obstructive sleep apnea syndrome[J].J Craniofac Surg,2016,27(4):1044-1048.DOI:10.1097/scs.0000000000002608.
[11]Serra-Torres S,Bellot-Arcís C,Montiel-Company JM,et al.Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome:a systematic review[J].Laryngoscope,2016,126(2):507-514.DOI:10.1002/lary.25505.
[12]Nikolopoulou M,Byraki A,Ahlberg J,et al.Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome:a randomized,placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems[J].J Oral Rehabil,2017,44(6):452-460.DOI:10.1111/joor.12505.
[13]宋学萍,于士龙,杨惠娟,等.应用经颅多普勒超声评价OSAHS患者脑血流储备的变化及其与突发性脑血管事件的关系[J].中华神经医学杂志,2015,14(5):493-496.DOI:10.3760/cma.j.issn.1671-8925.2015.05.013.
[14]Sam K,Peltenburg B,Conklin J,et al.Cerebrovascular reactivity and white matter integrity[J].Neurology,2016,87(22):2333-2339.DOI:10.1212/WNL.0000000000003373.
[15]Hegedu2I,Mili'c J,'Cosi'c A,et al.Cerebrovascular reactivity in acute hyperoxia in patients with acute ischaemic stroke[J].Brain Inj,2017,31(4):560-566.DOI:10.1080/02699052.2017.1280853.
[16]Cardim D,Schmidt B,Robba C,et al.Transcranial Doppler monitoring of intracranial pressure plateau waves[J].Neurocrit Care,2017,26(3):330-338.DOI:10.1007/s12028-016-0356-5.
[17]Hernández Voth A,Sayas Catalán J,Benavides Ma1as P,et al.Obstructive sleep apnea-hypopnea syndrome in patients with severe chronic respiratory insufficiency[J].Med Clin(Barc),2017,148(10):449-452.DOI:10.1016/j.medcli.2016.12.043.
[18]Afonso Delgado L,Micoulaud Franchi JA,Monteyrol PJ,et al.Implantable nerve stimulation for obstructive sleep apnea hypopnea syndrome[J].Presse Med,2016,45(2):183-192.DOI:10.1016/j.lpm.2015.11.008.