| Parti Characteristics of sleep structure in patients with positional obstructive sleep apnea syndromeObjective:Compare the clinical features and sleep parameters of positional OSAS(POSAS)and non-positional OSAS(NPOSAS).Methods:This study consists of two parts.(1)The general clinical features of patients with positional obstructive sleep apnea syndrome(POSAS).Case-control design,A total of 403 consecutive patients with OSAS enrolled.The POSAS was defined as having an overall apnea-hypopnea index(AHI)>5 with supine AHI>2 times the non-supine AHI.From the database of OSAS of the department of neurology in Changzheng hospital,screened 170 cases(male 123,female 47,mean age 49.4±13.4)of POSAS,we analyzed the general clinical features of POSAS.(2)Characteristics of sleep structure in patients with positional OSAS.Clinical data,Epworth Sleepiness Scale(ESS),Berlin questionnaire and Stop-Bang questionnaire are collected respectively before polysomnography.The PSG sleep parameters of 403 patients with OSAS were recorded and compared between the POSAS group and the NPOSAS group.Comparison between the two groups using independent sample t test,count data using chi square test.Results:1.A total of 403 patients with OSAS were interviewed,170(42.2%)met the diagnostic criteria of POSAS.Neck circumference,waist circumference and BMI were significant lower than control group(p<0.05).2.N1 was significantly shorter in POSAS group,but N2,N3 and REM sleep time was longer;The total value of AHI was significantly lower than that of NPOSAS group(23.50118.83vs.50.52129.58,p<0.001),but also has lower supine AHI(28.08±125.94vs.40.14±25.16,p<0.001)and the left and right lateral position(10.89± 17.77vs.16.50±24.38,p=0.010 and 10.91 ± 18.47vs.17.15±22.91,p=0.004).3.The number of awakening leg movement(LM),periodic leg movement index(PLMS index)of the POSAS group,were lower than those in group NPOSAS,and there were statistically significant(p<0.05 or p<0.01);waking and sleeping heart rate lower than NPOSAS patients(the distribution of the p<0.05 and p<0.01).Conclusions:1.Compared with the patients with non positional OSAS,the patients with positional OSAS had better sleep structure,lower incidence of respiratory events,micro arousal,leg movements during sleep and higher sleep quality.2.Regardless of awake or sleep period,the heart rate of patients with POSAS is lower than that of NPOSAS,and the risk of cardiovascular disease is also reduced.The reason may be related to the role of body position.Part2 Analysis of heart rate variability in patients with positional obstructive sleep apnea syndromeObjective:Compare the heart rate variability characteristics of both POSAS and NPOSAS groups.Methods:A total of 170 patients with POSAS(male 123,female 47,mean age 49.4±13.4 years)were included from 2014.1-2016.12.Two hundred and thirty-three patients with NPOSAS(male 178,female 47,mean age 46.4±11.8 years)with age,sex and BMI matched were enrolled.The diagnostic criteria of positional OSAS are the same as the first part.With respect to HRV analysis,we select some representative methods,such as time domain method,Frequency domain method,PoincarePlot,detrended fluctuation analysis(DFA)and so on.To provide an important reference index for the comprehensive and objective evaluation of autonomic nervous system activity and the identification of OSAS.One hundred and seventy patientsdiagnosed with POSAS were compared to 233 NPOSAS patients,matched in age and gender.The differences between POSAS group and NPOSAS group were compared.Statistical analyses included independent samples t test and Pearson correlation analysis.Results:1.Compared with the control group,there was no statistical difference in the time domain parameters SDANN of POSAS patients,the other parameters such as SDNN,SDNNI,RMSSD and PNN50 were statistically significant(p<0.05 and p<0.01),respectively;2.In the frequency domain analysis,POSAS group compared with NPOSAS group,the percentage of extremely low frequency power(VLF%)and the percentage of low frequency power(LF%)were increased,while the high frequency power(HF),the ratio of low frequency power and high frequency power(LF/HF)decreased,the above four indexes in the two groups have significant differences(all p<0.01).3.There were significant differences in SDNN,SDNNI and frequency domain indexes VLF,LF and LF/HF between HRV and POSAS(p<0.05 or p<0.01)in different positions and before and after waking and 15 minutes after waking up.4.E/A was positively correlated with VLF,LF and LF/HW in patients with POSAS,and the correlation between AHI and LF/HF was the strongest.Conclusions:Autonomic nerve function in patients with OSAS,reduce cardiovascular targeting serious damage,and may even lead to sudden death and other adverse outcomes,but POSAS patients compared with NPOSAS patients,mild disease,cardiac vulnerability is small,considering the position factors that might be in which play a key role.Part3 Study on the effect of different intervention methods on patients with positional obstructive sleep apnea syndromeObjective:Aim to investigate the effect of positional therapy and ventilator therapy in patients with OS AS.Methods:This study consists of two parts.(1)Effect of positional therapy on patients with mild to moderate OSAS.(2)Effects of different intervention methods on moderate POSAS patients.Forty POSAS patients(male 29,female 11,mean age 50.7 years,BMI 27.8kg/m2),Forty seven NPOSAS patients(male 35,female 12,mean age 49.8 years,BMI 30.3kg/m2).The patients were divided into mild,moderate and severe OSAS according to AHI,we observe the changes of sleep structure and heart rate variability before and after PT in patients with mild to moderate OSAS and investigate the effect of different intervention methods on patients with moderate POSAS.Statistical analyses included independent samples t test and repeated-measurement covariance.Results:1.Comparison of postural therapy in patients with mild to moderate POSAS and NPOSAS.The changes of PSG parameters of the two groups of patients before and after treatment:posture parameters of patients with mild POSAS were lower than that in NPOSAS patients,the percentage of N1 phase and supine sleep time,AHI,LSaO2 and arousal index exists significant(p<0.05 or p<0.01);changes of HRV parameters of the two groups of patients before and after treatment,SDANN group:mild posture PNN50 and LF%,HF%and LF/HF frequency domain indexes were statistically significant(p<0.05 or p<0.01);time domain index in the moderate group,SDNN RMSSD and LF%,LF/Hf and frequency domain indexes were statistically significant(p<0.05 or p<0.01).2.Comparison of moderate POSAS patients,CPAP treatment of postural therapy:through the measurement of PSG parameters in patients with moderate POSAS postural therapy and CPAP treatment,after two treatments the microarousal index decreased but there was no statistical significance(P<0.05);decreased by HRV after PT and CPAP treatment parameters were moderate POSAS patients,but there was no statistically significant each index(P<0.05).Conclusions:Especially for OSAS POSAS patients,PT can effectively improve sleep structure,improve arterial oxygen saturation,correct sleep disordered breathing,and its function is similar to CPAP. |
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