| Obstructive sleep apnea hypopnea syndrome(OSAHS)is a potentially dangerous high incidence of disease,which is in the process of sleep respiratory collapse caused by insufficient ventilation stenosis,apnea,accompanied by snoring,sleep disorders,frequent occurrence of oxygen desaturation,daytime symptoms such as addicted to saliva.The methods to treat patients with OSAHS at home and abroad mainly include basic treatment,drug therapy,continuous positive airway pressure and ENT surgery,but part of the effect of uvulopalatopharyngoplasty(UPPP)is poor at the long term.Some patients with OSAHS even without snoring,make the disease more insidious and lead to disease progression,bringing greater harm to the body.Continuous positive airway pressure(CPAP)with positive airway pressure can effectively improve the airway with the positive airway pressure,can reduce or even eliminate the repeated occurrence of sleep apnea(low ventilation)on patients with OSAHS.Promotin patients with sleep apnea(Low ventilation,the patients)ane the d the average of SpO2 level and the lowest at night and nocturnal SpO2 increased,can improvee the symptoms in a short period of time.After CPAP treatment,the survival rate of OSAHS increased significantly at,a the long-term effect,after CPAP treatment,the survival rate of OSAHS increased significantly,CPAP is the current domestic and international consensus of the treatment of OSAHS effective way CPAP therapy was recommended as the initial treatment of patients with OSAHS(strong recommendation,moderate level of evidence)by The American College of physicians in the Department of internal medicine of obstructive sleep apnea hypopnea syndrome treatment guidelines.Currently,polysomnography is the gold standard to monitor the patient’s condition,but the cost is high and lack of basic medical equipment,making polysomnography not easy to carry out.Epworth sleepiness score(ESS)is subjective.In clinical work,we often encounter patients with secondary OSAHS red blood cell(RBC)increased,hemoglobin(HGB)and increased hematocrit(HCT)elevated,sometimes as high as 60%,and increased with the aggravation of more.With RBC,HGB increased and HCT increased in patients bymonitoring RBC HGB,HCT,change,inspection in patients treated with CPAP OSAHS effect,has good objectivity and good social and economic benefits,this is our research direction.Objective: To understand the clinical characteristics of OSAHS patients,to explore the effect of RBC,HGB,HCT in the assessment of OSAHS patient’s condition with the increasing of RBC,HGB,HCT,which order to provide scientific basis for the development of OSAHS patients in the future.Methods: selected 30 cases of patients diagnosed with OSAHS complicated with red cell increased in our hospital as the research object from January 2015 to May 2015.Male 28 cases,female 2 cases,average age 41.36 years old,minimum 20 years old,maximum 61 years old,average body mass index(BMI)was(27.52±3.25)Kg/m2.ESS was 15.13±1.38,the average of apnea hypopnea index(AHI),LSp O2,RBC,HGB,HCT were 41.92±18.32,0.66±0.06,(5.69±0.43)×1012/L,(161.80±11.39)g/L,0.56±0.10,respectively.Among them,12 cases were complicated with hypertension,combing use of antihypertensive drugs,4 patients with 3 or more.2patients with diabetes mellitus,the amount of insulin used in the daily 30 U,by used CPAP therapy for patients before,1 week and 1 month after the RBC,HGB,HCT,ESS,AHI,LSp O2 results are observed and analyzed.Patients’ treatment were on basis of the weight loss,night to avoid excessive fatigue,drinking and taking sleeping pills and stimulants,et al.Using AutoCPAP ventilator(Kaidi Thai Futong)to treat the patients.30 cases of patients in sleep laboratory for the first night of multichannel sleep monitoring,received the second night all night AutoCPAP ventilator in the treatment of and according to the patient’s condition,selection of nasal mask or hood,using delay boost therapy initiation pressure 4-6cmH2 O while monitoring index of blood oxygen saturation,snoring,chest and abdominal movements.Ventilator can be automatic continuous positive pressure to snoring disappeared,and can eliminate patients in various stages of sleep and postural changes of apnea and hypopnea,maintain the sleep The lowest oxygen saturation during sleep LSp O2>0.90.On the third day began at home for treatment of AutoCPAP.On the third day began at home for treatment of AutoCPAP.Every night of treatment for at least 4 hours or more,and in the first week daily telephone follow-up,the second week,the weekly at least twicetelephone follow-up to solve problems in the course of treatment,guarantee treatment time and effect.Comparing the changes of RBC,HGB,HCT,ESS AHI,and LSpO2.Results:1.30 cases were included in the study.The AutoCPAP automatic pressure tracking was determined in the treatment process.Mean pressure value was 14.61±3.72cmH2 O.Per night on average treatment time was 5.76 ±1.28 hours.The patients with CPAP after 1 weeks of treatment,12 patients with hypertension in 6 patients to reduce the dose and type of antihypertensive drug use of antihypertensive drugs,but there are still 6 cases still need to use the same dose and type,2 cases of patients with diabetes better than before,but still need to use the same dose.One month later after CPAP treatment,among 12 cases,there were 10 patients reduce the dose and type of antihypertensives,2 patients discontinued antihypertensive drugs,2 patients with diabetes who used 30 R of insulin aspart reducing doses of 8 U or more.2.RBC(F=40.79,P <0.001),HGB,HCT,ESS score,AHI and LSp O2(P<0.001)before treatment,one week later and one month later,showed statistically significant difference among them.Further analysis showed that,for RBC there were no statistically significant differences(P =0.362)between before treatment and one week later,but not showed between before treatment and one month later(P<0.001),also between one week later and one month later(P<0.001).Multiple comparison analysis showed that,HGB,HCT,ESS score,AHI and LSp O2,The difference was statistically significant(all,P<0.05)in before treatment and one month later.But for HGB(P=0.461)and HCT(P =0.322),there were no statistically significant difference,while the scores of ESS,AHI and LSpO2 indexs was statistically significant between one week later one month later(P<0.05)but not between AHI(P =0.213)and LSpO2(P=0.305).Conclusion:1.With CPAP treatment,OSAHS patients can improve airflow limitation and reduce the occurrence of hypoxemia,thus RBC,HGB and HCT in circulating blood decreased to normal range.CPAP therapy was effective in the initial treatment.2,with RBC,HGB,HCT elevated in patients with moderate to severe OSAHS in short-term CPAP treatment under the condition of patients with ESS score inassessing the efficacy of patients.But in the long term evaluation of the ESS score in patients with moderate to severe OSAHS may not be reliable,the need to increase the sample size,do further study.3,RBC,HGB,HCT in patients with RBC,HGB,HCT,increased in patients with OSAHS,as the efficacy of the evaluation index is better than the ESS score,with good objectivity and authenticity. |
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