Relationship And Mechanism Between Hypoxia And Periodic Limb Movements In Sleep, Microarousal And Fasting Plasma Glucose In Severe OSAHS

Objective: To compare the parameters of sleep monitoring in patients with severe and non-severe obstructive sleep apnea hypopnea syndrome(OSAHS);To study the relationship between hypoxia and periodic limb movements in sleep(PLMS),microarousal,and fasting plasma glucose(FPG)in severe OSAHS patients.Methods: According to the strict inclusion and exclusion criteria,150 OSAHS patients who attended the otolaryngology department of our hospital for sleep snoring and apnea would be monitored by polysomnogram.After screening the data,79 patients met the requirements.Based on the results of apnea–hypopnea index(AHI),subjects were divided into severe OSAHS(AHI≥30 times / h)and non-severe OSAHS(AHI <30times / h).Then,we needed record their name,age,height,weight,diabetes or hypertension,tongue position and tonsil size,and indicators of polysomnogram(PSG).In addition,according to the results of PSG,the correlation between the lowest oxygen saturation(LSa O2)and PLMS,microarousal,FPG and the correlation among PLMS,microarousal,and FPG were analyzed.The data of normally distributed are expressed by (?)±s,the statistical method was independent sample t-test.Non-normally distributed data were represented by the median(interquartile range),and the statistical method was wilcoxon signed-rank test.Qualitative data were denoted by frequency and rate,which were analyzed by chi-square test.The analysis of pearson correlation was used to study the correlation of different indicators.P<0.05 indicates statistical difference,and P<0.01 indicates statistically significant difference.All the analysis of data in this topic was repeated more than three times to ensure the accuracy of the final results.Results: First,there was statistically difference in height between severe OSAHS and non-severe OSAHS group.However,there were no significant differences in sex ratio,age,weight,BMI,tongue position,tonsil size,ESS score,diabetes,or hypertension.Second,in the respiratory event,there was statistically difference in apnea index between severe OSAHS and non-severe OSAHS groups,but there was no statistical difference in the maximum duration of apnea;In the anoxia event,there was statistical difference in the numbers of oxygen reduction,mean oxygen saturation,minimum duration of oxygen reduction,maximum duration of oxygen reduction,average duration of oxygen reduction in severe OSAHS and non-severe OSAHS;In the sleep structure,only stage II was statistical difference between severe OSAHS and non-severe OSAHS,there were no statistical difference in stage I,stage III,stage IV and sleep efficiency;In the PLMS,the number of limb movements during sleep of stage III/IV in the two groups was statistical difference,limb movements produced by sleep in REM and stage I/II were not statistical differences;In the microarousal,the microarousal produced by stage REM,stage III / IV of sleep,oxygen reduction,the changes of heart rate,and sleep disturbance were not statistical differences,the microarousal produced by stage I/II of sleep and periodic limb movements were not statistically significant;what’s more,there was no statistical difference in morning fasting blood glucose between the two groups.Third,there was no correlation between PLMS,morning FPG and LSa O2.However,LSa O2 inversely correlated with microarousal index;Fourth,the PLMS showed weak correlation with microarousal in severe OSAHS patients,and was not correlation with morning FPG.Meanwhile,it’s no correlation between PLMS and morning FPG.Conclusion: Firstly: patients with severe OSAHS were usually older,having a fat body,showing more severe symptoms of snoring,apnea,daytime sleepiness.They were more prone to have cardiovascular and cerebrovascular diseases such as hypertension and diabetes than non-severe OSAHS patients.At the same time,their growth and development were limited.Secondly: there was no correlation between LSa O2 and PLMS and morning FPG in severe OSAHS.But it showed a negative correlation between LSa O2 and microarousal produce by stage REM,accompanying by oxygen reduction,the changes of heart rate and sleep disorders.Thirdly: There was no correlation between morning FPG and microarousal and PLMS in severe OSAHS patients,PLMS were positively correlated with microarousal,while PLMS could reduce microarousal caused by sleep disorders.They complemented each other and can be used together to assess the severity of OSAHS patients and guide treatment.