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目的:探讨一种基于快速动眼睡眠期(REM)相关的阻塞性睡眠呼吸暂停事件(OSA)发生特征的分型方法及潜在临床意义。方法:250例OSA患者根据PSG分型:REM期相关组[RrOSA,REM期AHI与非REM期AHI(NREM-AHI)比值(R)>1,113例],非REM期相关组(NRrOSA,R≤1,137例);RrOSA组进一步分为RrOSAⅠ型(R≥2,34例)与RrOSAⅡ型(R>1,79例)。RrOSAⅠ型再根据非REM期AHI分为2个亚型:RrOASⅠa型(NREM_AHI<15,24例)与RrOSAⅠb型(NREM_AHI≥15,10例)。比较各分组PSG与临床数据。结果:RrOSA组患者AHI、ODI、NREM_AHI、NREM_ODI、REM期最大氧减、REM期最长氧减时间、NREM期最长氧减时间均显著低于NRrOSA组患者(均P<0.01)。REM期AHI或ODI 2组间无差异(P>0.05)。RrOSA各亚组之间REM期(AHI、ODI、最大氧减、最长氧减时间)、NREM期(AHI、ODI、最大氧减、最长氧减时间)均存在逐渐升高趋势。部分RrOSAⅠa组患者不耐受CPAP治疗,改用APAP治疗后效果满意。结论:对RrOSA进行进一步分组分析不同分期睡眠参数改变有助于了解OSA病程发生、发展。RrOSAⅠa分组对CPAP治疗模式选择可能存在指导意义。RrOSA可能是OSA患者中的一种特殊类型,这种类型可能随着病情严重而发展为其他类型。
OBJECTIVE: To investigate the classification of obstructive sleep apnea (OSA) based on rapid eye movement sleep (REM) and its potential clinical significance. Methods: Two hundred and seventy OSA patients were divided into two groups according to PSG classification: the related group [NRROSA, REM AHI (NREM-AHI) ratio> 1,113) 1,137). The RrOSA group was further divided into RrOSA type I (R≥2,34) and RrOSA type II (R> 1,79). RrOSA type I was divided into two subtypes according to non-REM AHI: RrOASⅠa type (NREM_AHI <15,24 cases) and RrOSA Ⅰb type (NREM_AHI≥15,10 cases). PSG and clinical data were compared between groups. Results: The maximal oxygen deprivation in AHI, ODI, NREM_AHI, NREM_ODI and REM, the longest oxygen deprivation in REM and the longest duration of oxygen deprivation in NREM were significantly lower in patients with RrOSA than those in patients with NRrOSA (all P <0.01). There was no difference between REM AHI and ODI 2 groups (P> 0.05). The REM durations (AHI, ODI, maximum oxygen reduction, maximum oxygen reduction time) and NREM (AHI, ODI, maximum oxygen reduction, maximum oxygen reduction time) between RrOSA subgroups all increased gradually. Some patients in RrOSAⅠa group were intolerant of CPAP treatment and were switched to APAP with satisfactory results. CONCLUSIONS: Further group analysis of RrOSA changes in sleep parameters in different stages helps to understand the occurrence and development of OSA. The RrOSA Ia subgroup may be instructive in the choice of treatment modality for CPAP. RrOSA may be a specific type of OSA patient, and this type may develop as other types as the condition progresses.