Clinical Research Of Continuous Positive Airway Pressure For Perioperative Period In Patients With Obstructive Sleep Apnea Hypopnea Syndrome

Objective To investigate variations of the ploysomnographic indice and analyze the effects of continuous positive airway pressure(CPAP)in perioperative treatment for patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and also observe if there is any benefits for improving patients' condition,raising tolerance for surgery, reducing risk and surgery complications.Methods Thirty six OSAHS patients were included in this study,they were graduated as mild,moderate and severe OSAHS patient groups with the standard of the graduation on patients with OSAHS made in Hangzhou 2002.All cases' preoperative diagnosis were confirmed with PSG,and all had second PSG on first night of the CPAP treatment.Two nights PSG results were compared,the parameters included sleep architecture,breathing events,arousal and oxygen desaturation.Another nine cases with simple snoring were drown random as control.Use the t test to analyze the difference on paramaters between patients with OSAHS and control,the difference between before and after CPAP treatment,and the change of OSAHS patients after the CPAP treatment.Use variance analysis and LSD test to analyze the difference on paramaters among mild,moderate and severe OSAHS patient groups.Results1 Compare the parameters between OSAHS of different degree and control.1)Only AHI has significant difference in statistics between OSAHS patient in mild groups and the control.The microarousal index(MI)of moderate and severe groups were increased. Stageâ… increase obviously,but stageâ…¢+â…¤and REM stage sleep decrease obviously in severe groups.With the increase of apnea hypopnea index(AHI),LSaO₂ reduced and rate of SAO₂＜90%increased.2)The parameters among the patients in mild,moderate and severe groups,stageâ…¢+â…¤,MI,LSaO₂ and AHI had the significant difference(P＜0.05).There is no difference in stageâ…¢+â…¤between mild and moderate group,but the moderate and severe group had.Among mild,moderate and severe groups,AHI had the diviation obviously.And between mild and severe,moderate and severe groups,MI and LSaO₂ had the significant difference.2 Compare the parameters in OSAHS patients between before and after the CPAP treatment.1)For all the OSAHS cases,the sleep efficiency,sleep latency,REM latency and stageâ…¡had no deviation,stageâ… ,stageâ…¢+â…¤,REM sleep,MI,AHI,LSaO₂ and rate of SAO₂＜90%had the significant difference.2)After the CPAP treatment,change of AHI and LSaO₂ had significant difference in mild group;AHI,LSaO₂ and MI had significant difference in moderate group;AHI,LSaO₂,rate of SaO₂＜90%,stageâ… ,stageâ…¢+â…¤,REM sleep had significant difference.3)After the CPAP treatment,the parameters among mild,moderate and severe OSAHS patient groups had no deviation. 4)The parameters had no deviation between OSAHS patients after CPAP treatment and the control.3 Improving of symptom and condition of OSAHS patients.After the five to seven days' CPAP treatment and the atomization treatment,respiratory disturbance released, headache and Dry mouth lessened or disappeared,the hyperemia and dropsy of soft palate,uvula palatine and the tonsil lessened obviously.Monitoring of blood pressure before and after sleep shown:blood pressure trended toward normal gradually.The blood pressure was steady in perioperative period,and had no hypertensive crisis.The OSAHS patients on local anesthesia can go with the surgery,and had no temporary dyspnea, breath holding,apopsychia and restlessness.All patients bleeding slightly,and about 20-60ml.and all had 2-3 days CPAP and atomization treatment,their condition was steady.Conclusion 1 With the increasing of AHI,OSAHS patients had sleep architecture disturbance, iterative microarousal and sleep interruption.The parameters had no significant difference between mild and moderate groups,but mild and moderate groups had the significant difference with severe group.The respiratory disturbance more serious,the patients' condition worse.2 After the effective CPAP treatment,sleep architecture and respiratory was improved obviously,sleep interruption was corrected,sleep architecture trended toward normal. Patients' parameters in saturation of blood oxygen increased significantly,and the condition of blood oxygen was improved.3 After the CPAP treatment,parameters of OSAHS patients in different groups got close to normal.The change of parameters had deviation,but they all can get to approximate normal.4 Effective CPAP treatment can improve sleep architecture and saturation of blood oxygen,increase the respiratory driving force,lessen the local edema and hyperemia in the pharyngeal cavity,raise the blood and oxygen supply to the important organs for life.Raising tolerance for surgery and anesthesia.The effective CPAP treatment had clinical significance for reducing perioperative risk and surgery complications,it should be considered as an important measure for reducing perioperative risk and surgery complications.