Analysis Of TCM Constitution And Syndrome Characteristics In Patients With Obstructive Sleep Apnea-hypopnea Syndrom

This paper includes two parts:literature review and clinical research.The western medicine part of the literature review summarizes the research progress of the disease from four aspects:the prevalence,risk factors,clinical manifestations and treatment of obstructive sleep apnea hypopnea syndrome(OSAHS).The literature review of traditional Chinese medicine summarizes the ancient Chinese doctors’ uderstanding of snoring,the constitution of obstructive sleep apnea,and the modern TCM clinical research on TCM syndromes and treatments,and analyzes the common syndromes and symptoms and the corresponding Chinese medicine compound.in some published literatures through bibliometric methods.In the clinical research part:Objective:1.To summarize the characteristics of OSAHS TCM syndromes and common TCM constitutions;2.To analyze the risk factors of different OSAHS grades;3.To compare the level of daytime sleepiness in OSAHS patients of different TCM constitutionsMethods:Patients who attended the Sleep Center of Respiratory Department of Peking University People’s Hospital from October 2018 to December 2019 and met the OSAHS diagnostic criteria of the Chinese Medical Association’s "Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome(2011 Revised Edition)" were surveyed through the on-site questionnaire.The general condition,the TCM constitution scale,the TCM symptoms,signs,tongue and pulse information and the Epworth Sleepiness Scale(ESS)score of selected patients were collected,and the TCM constitution type and severity of OSAHS were divided by reference to the judgment standard.Use Epidata3.1 to convert paper questionnaire into electronic version,use EXCEL to establish a database.Descriptive statistics are used for the frequency and percentage of each variable,use COOC software to visualize TCM constitution co-occurrence;use SPSS 22.0 to perform principal component analysis to summarize TCM syndromes based on symptom items in patients with mild to moderate OSAHS and severe OSAHS;two classification variables were set up with whether the OSAHS condition was mild,moderate,or severe respectively,and binary logistic regression was used to assess the influence of phlegm constitution,gender,smoking history and body mass index(BMI)on the degree of disease,and to screen the risk predictors of different degree of disease.Results:1.This study investigated a total of 152 patients with OSAHS.The age range of the patients ranged from 19 to 81 years old,with an average age of 47.58±16.59 years old.Patients under 60 accounted for 74.3%of the total;109 male patients,accounting for 71.7%,and 43 female patients,accounting for 28.3%.The average BMI was 27.96±4.38kg/m2,and overweight(BMI≥24kg/m2)patients accounted for 86.9%of the total surveyed patients;the average AHI was 37.81±26.12 times/h,and the patients with severe OSAHS accounted for half(50.7%).Hypertension,hyperlipidemia,coronary heart disease,hepatobiliary disease are common complications2.124 patients had a comfirmed constitution,fifty-seven patients(37.5%)were single-type constitution,including 22 cases of balanced constitution,8 cases of Qi-deficiency constitution,7 cases of phlegm-damp constitution,7 cases of Yin-deficiency constitution,7 cases of Yang-deficiency constitution,3 cases of damp-heat constitution,and 2 cases of blood stasis constitution and 1 case of allergic constitution.67 people(44.1%)had two or more constitutions.The biased constitutions accounted for 82.3%of total objects.Calculate the frequency according to the number of appearances of each constitution after splitting combined constitution,phlegm-dampness,Qi-deficiency,Yin-deficiency,and damp-heat are the main constitutions of OSAHS,accounting for 17.25%,16.29%,15.97%,and 11.18,respectively.The results of co-occurrence analysis showed that phlegm-dampness+qi deficiency,phlegm-dampness+yin deficiency,Qi-deficiency+yin deficiency,and phlegm-dampness+dampness-heat were the most common co-occurrence constitutions.According to the statistical results of 25 patients who calculated the tendency constitution,the Qi-deficiency constitution is the most common tendency constitution.There are 3 persons with neither confirmed constitution nor tendency constitution.3.After splitting the patient’s tongue and pulse elements according to tongue color,tongue shape,tongue coating,and pulse condition,the percentages in each category are calculated.Pale red tongue,fissured tongue,thin white tongue coating,wiry and slippery pulse are the main tongue and pulse conditions,which account for 42.11%of tongue color,54.29%of tongue coating,36.82%of tongue shape and 55.36%of pulse condition,respectively.Red tongue appeared 39 times,dark red tongue appeared 45 times,a total of 84 times,accounting for 55.26%of the total tongue color.47 times with greasy coating,30 times with white coating,accounting for 38.31%of the total tongue coating distribution,and 27 times with thin yellow coating and yellow coating,accounting for 13.43%of the distribution of the tongue coating,wiry pulse and slippery pulse appeared 75 times each,accounting for 55.36%of the pulse condition,rapid pulse appeared 24 times,accounting for 8.86%of the pulse condition.Preliminary evidence through tongue and pulse that OSAHS patients with excess syndrome account for most of the total,and the main pathological factors may involve heat,phlegm and dampness;12 cases had fat tongue with tooth indentation,19 cases with cracked tongue coating.There were patients with less tongue coating and shedding of tongue coating,and there were 44 cases with sunken pulse and 36 cases with narrow pulse,indicating the existence of yin deficiency and qi deficiency in the deficiency syndromes.The overall tongue and pulse indicated that OSAHS had a mixture of deficiency and excess,deficiency in origin and excess in superficiality.4.The most common TCM symptoms of patients with OSAHS are fatigue,accounting for 59.21%of the total patients,other common symptoms and signs that account for more than 50%include:abdomen plump(53.29%),thirst and desire to drink(50.66%).5.Through co-occurrence cluster analysis,the syndrome groups are divided into 4 subgroups,namely:lung-spleen deficiency,phlegm-dampness syndrome,damp-heat syndrome,liver Qi stagnation syndrome.Taking the OSAHS grade mild to moderate and severe as the segmentation points,principal component analysis is used to extract the main symptoms of patients with different levels of the disease to summarize the syndromes.The main syndromes of mild to moderate patients include:liver Qi stagnation syndrome,phlegm-dampness syndrome,lung-spleen deficiency syndrome;the main syndromes of severe patients include:liver Qi stagnation syndrome,damp-heat syndrome,lung-spleen deficiency.According to the 4 types of syndromes obtained by cluster analysis,the syndrome of each of the 152 patients in this study were judged.There were 81 people with single syndrome,accounting for 53.29%,and 41 persons with 2-syndrome accounting for 26.97%,a total of 20 persons with 3-syndrome,accounting for 13.16%,and 10 persons with 4-syndrome,accounting for 6.6%.Among the single syndrome,the lung-spleen deficiency syndrome is the most common syndrome,followed by the phlegm-dampness syndrome.2-syndrome group is the most common in the multiple syndromes.lung-spleen deficiency syndrome+phlegm-dampness syndrome is the most frequent combination syndrome.Among the 3-syndrome group,lung-spleen deficiency syndrome+phlegm-dampness syndrome+damp-heat syndrome is most common."Wet" elements accounted for the highest proportion of syndromes in this study.6.Taking the severity of OSAHS as the dependent variable,the Mantel-Haenszelχ2 test was used to analyze the influencing factors of OSAHS.The results showed that gender,BMI≥24kg/m2,smoking history,and phlegm-damp constitution had statistically significant influences on different severity of OSAHS.Next,the four factors were included as independent variables,and the two-category Logistic regression analysis was performed based on whether the disease was mild,moderate,or severe.The BMI score in the severe patient group Logistic model was statistically significant,compared with patients with 18.5≤BMI(kg/m2)<24,when BMI(kg/m2)≥24,patients with overweight and obesity have a higher risk of severe disease.In the Logistic model of patients with mild disease,males have a higher risk of disease than females.7.One-way analysis of variance judged that the difference in Epworth Sleepiness Scale scores between different constitution groups was statistically significant(F=2.37,p=0.02).The results of the LSD test showed that compared with the ESS score of the balanced constitution group,the Qi deficiency constitution was higher by 3.19(P=0.024,95%CI 0.42-5.96),the damp-heat constitution was higher by 4.10(P=0.007,95%CI 1.12-7.09),the phlegm dampness constitution was higher by 4.09(P=0.002,95%CI 1.51-6.67).Compared with the ESS score of the Yang deficiency constitution group,the damp heat constitution was higher by 4.54(P=0.024,95%CI 0.61-8.47),the phlegm dampness constitution was higher by 4.53(P=0.015,95%CI 0.90-8.15).Conclusion:1.The TCM constitution characteristics of OSAHS patients are mainly biased constitution.The most common constitutions include:phlegm-dampness,Qi-deficiency,Yin-deficiency,and damp-heat constitution.2.Phlegm-dampness syndrome,damp-heat syndrome,liver Qi stagnation syndrome and lung-spleen deficiency syndrome are common syndromes in patients with OSAHS,among which liver Qi stagnation syndrome is seen in all grades of OSAHS.The syndrome types of mild to moderate patients and severe patients are slightly different,and "wet" is the main syndrome element.3.Gender(male),overweight and obese(BMI≥24kg/m2),smoking history,and phlegm constitution affect the severity of OSAHS.Men have a higher risk of mild OSAHS than women,and overweight aggravates the condition of OSAHS.4.The symptoms of daytime sleepiness in patients with biased constitution are more serious than those with balanced constitution.5.This study is based on the idea of combination of "TCM constitution differentiation,syndrome differentiation and disease differentiation",using a cross-sectional study to summarize the characteristics of the main constitution and group syndrome types of OSAHS patients,in order to target the phlegm-dampness constitution with "wet" syndrome element of OSAHS patients and provide research data on precise medication of this group in the future.