The Clinical Study On The Pulmonary Thromboembolism And Sleep Apnea Hypopnea Syndrome

Objective:To discuss the basic clinical characteristics of the acute pulmonary embolismpatients with sleep apnea hypopnea syndrome.Based on daytime and nocturnal hypoxia,carbon dioxide pressure,the PSG results,daytime sleepiness,and so on,we investigate the effect of sleep apnea hypopnea syndrome on pulmonary embolism.Method:To select 30 patients with acute pulmonary embolism in the Department of respiratory medicine of Tianjin medical university general hospital from March 2017to February 2018,who were clear diagnosed by spiral CT pulmonary angiography.All patients were tested of polysomnography（PSG）and transcutaneous CO₂ pressure（TcPCO₂）monitor within 1 weeks of the onset of pulmonary embolism.According to the results of apnea hypoventilation index（AHI）,patients were divided into pure APE group（10 cases）and APE combined sleep apnea hypopnea syndrome group（20cases）.Then compare the clinical characteristics and the index of the PSG,TcPCO₂,the blood gas analysis.Result:1.In the 30 patients with acute pulmonary embolism,we found 10 patients with pure APE,20 patients with SAHS,moreover there were 4 patients with periodic central apnea in the SAHS patients.2.Basic clinical data of two groups of patientsThe gender,history of hypertension,diabetes,coronary heart disease and DVT,smoking history in tho groups showed no significant differences（p>0.05）.Compared the pure APE group,the SAHS group were younger,neck circumference,BMI and the score ESS was bigger,the area of embolic embolism is more extensive and the proportion of unknown risk factors was more than the pure APE group,P<0.05,the differences were statistically significant.3.The PSG data with two groups of patientsThe AI,AHI,ODI,Arl,SLT90,TcPCO₂ was higher than the pure APE group,LSaO₂ was lower than the pure APE group,suggesting the patients with SAHS have a more severe sleep disorder and hypoxic degree.P<0.05,the differences were statistically significant.4.The blood gas analysis with two groups of patientsThe SAHS group,s PaO₂was lower than the pure APE group,the concentration of HCO₃^-was higher than the pure APE group,P<0.05,the differences were statistically significant.There was no statistically significant in PaCO₂.5.There were 4-case parents with cyclical central apnea in the SAHS patients.They were advanced age and had the lower BMI,TcPCO₂,PaCO₂,and the concentration of HCO₃^-,the differences were statistically significant.However,there was no significant difference in the score of ESS,AI,AHI,ODI,Arl,LSaO₂,SLT90%.6.There was a positive correlation between AHI and BMI,the score of ESS,neck circumference,cumulative number of pulmonary segments in pulmonary embolism,SLT90%,TcpCO₂ in APE patients,and negatively correlated with LSO2（correlation coefficient was 0.699,0.474,0.383,0.436,0.501,0.443,and-0.469）.Conclusion:1.In the 30 patients with acute pulmonary embolism,The acute pulmonary embolism parents with SAHS is dominated by OSAHS,and periodic central apnea may occur.2.SAHS may be a risk factor for pulmonary embolism,aggravate the hypoxic degree of pulmonary embolism and cause the disturbance of sleep and respiration,and can make the accumulative range of pulmonary embolism more extensive.The increase of neck circumference and BMI may be risk factors of acute pulmonary embolism.As for patients with no known risk of pulmonary embolism,we should increase screening for SAHS.3.Hypoxia and the decrease of PaCO₂ may be risk factors of acute pulmonary embolism with periodic central apnea.