The Clinical Research On Assessment Of Respiratory Function In Patients With Amyotrophic Lateral Sclerosis By Pulmonary Function Combined With Polysomnography

ObjectiveTo investigate the clinical characteristics of pulmonary function and sleep respiratory function in patients with amyotrophic lateral sclerosis(ALS),and to study the clinical value of pulmonary function and polysomnography(PSG)in assessment respiratory function in patients with ALS.MethodsPulmonary function and PSG were evaluated in 50 ALS patients,and the clinical characteristics of pulmonary function and sleep respiratory function in different affected segments and different clinical stages were analyzed.Correlation analysis was carried out on influential factors of forced vital capacity(FVC)and lowest pulse oxygen saturation(LSpO2),and the abnormal detection rate of pulmonary function and PSG was compared.Results1.Pulmonary function indicators:vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),peak expiratory flow(PEF),maximal voluntary ventilation maximum(MW),total lung volume(TLC),maximal inspiratory pressure(MIP),and maximum expiratory pressure(MEP)of patients in bulbar palsy group were lower than those in patients non-bulbar palsy group,and the differences between the two groups were statistically significant(P<0.05).All indexes in the thoracic medullary involvement group were lower than those in the normal thoracic medullary group,and the differences between the two groups of VC,FVC and FEV1 were statistically significant(P<0.05),In the assessment of ALS King’s College Staging of patients,there were statistically significant differences in the pulmonary function indicators in the four clinical stages(P<0.05).The pulmonary function indicators in stage 1 patients were lower than those in stage 2 patients,and the differences between the two groups were statistically significant(P<0.05).2.Results of sleep monitoring index:Sleep apnea hypopnea index(AHI):2.2(0.67～7.75)times/h;the lowest pulse oxygen saturation(LSp02):(87.76±3.79)%,mean pulse oxygen saturation(MSp02):(87.76±3.79%,pulse oxygen saturation of rapid eye movement(REM):(94.71±1.36)%,pulse oxygen saturation of non-rapid eye movement(NREM):(94.50±1.21)%.Among them,blood oxygen in LSp02 and SpO2 of REM were lower than the normal value,and the difference was statistically significant(P<0.05).The indexes of bulbar palsy group were lower than that of non-bulbar palsy group,but the difference between the two groups was not statistically significant(P>0.05).LSp02:85.00(81.00～90.00)%in the normal group was lower than that in the thoracic medulla involvement group:88.00(87.00～90.00)%,and the difference was statistically significant(P=0.037<0.05).There was no statistically significant difference between AHI,LSpO2,MSpO2,REM and NREM blood oxygen in 4 clinical stages(P>0.05).3.Correlation analysis of.FVC and LSpO2:FVC was positively.correlated with BMI,ALSFRS-R score and MEP,while FVC was not significantly correlated with onset age,course of disease,site of onset,AHI and LSpO2.LSp02 was negatively correlated with AHI,LSpO2 was positively correlated with Sp02 of NREM,and there was no significant correlation between LSpO2 and onset age,disease course,MIP,MEP,etc.4.Comparison of abnormal detection rate of pulmonary function and PSG indicators:the highest detection rate of LSpO2 indicators(66%),followed by AHI(32%),and the lowest detection rate of FVC indicators(28%),and the differences between the three indicators were statistically significant(P<0.05).Conclusion1.In the early stage of the disease,patients with ALS had an insidious decline in respiratory function.The respiratory dysfunction was mainly restricted pulmonary ventilation dysfunction,and the respiratory function decline was more obvious in patients with ALS who had bulbar palsy and thoracic medullary involvement.2.Most of ALS patients have nocturnal hypoxemia and hypoventilation,AHI and LSp02 can be used as early warning indicators of respiratory muscle involvement.3.Pulmonary function combined with polysomnography is of important clinical value in discovering the respiratory function decline of ALS,and guiding the patients with respiratory function decline to use noninvasive positive pressure ventilation as soon as possible.