徐悠　毛洪京　余正和　韩莉　杨莉莉　郑秋梅　丁秀梅

[關键词] 睡眠呼吸暂停低通气综合征;主观睡眠质量;性别差异;躯体症状

[中图分类号] R563.9          [文献标识码] B          [文章编号] 1673-9701（2021）17-0085-06

Gender differences and influencing factors of subjective sleep quality in patients with obstructive sleep apnea hypopnea syndrome

XU You   MAO Hongjing   YU Zhenghe   HAN Li   YANG Lili   ZHENG Qiumei   DING Xiumei

Sleep Disorders Center， Hangzhou Seventh People′s Hospital， Hangzhou   310013， China

[Abstract] Objective To explore the gender differences and influencing factors of subjective sleep quality in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） by comparing the subjective sleep quality and related factors between male and female patients with OSAHS. Methods Eighty-two male patients and thirty-one female patients diagnosed with OSAHS in Department of Sleep Disorders of our hospital from January 2019 to May 2020 were included in the study. Scales were used to evaluate the subjective sleep quality （PSQI），the anxiety degree （GAD-7）， the depression degree （PHQ-9）， the physical symptoms （PHQ-15）， and the sleepiness degree （ESS）. Results The age of male patients （47.0 years old） was younger than that of female patients （56.3 years old）; BMI of male patients （27.0 kg/m2） was higher than that of female patients （24.7 kg/m2）; AHI of male patients （18.5 times/h） was higher than that of female patients （11.7 times/h）; the longest apnea time of male patients （48.0s） was higher than that of female patients （33.0s）; the average apnea time of male patients （24.5 s） was higher than that of female patients （19.0 s）; the lowest oxygen saturation of male patients （82.5%） was lower than that of female patients （86.0%）. The subjective sleep quality of female patients （PSQI=16 scores） was poorer than that of male patients （PSQI=13 scores）， and the sleepiness degree of female patients （ESS=5 scores） was not as obvious as that of male patients （ESS=7 scores）， with statically significant differences （P<0.05）. The age group （B=0.804）， the depression degree （B=1.314）， and the physical symptoms （B=1.159） could predict the subjective sleep quality of male patients; the physical symptoms （B=3.288） and the longest apnea hypopnea time （B=0.173） could predict the subjective sleep quality of female patients. Conclusion There is difference in subjective sleep quality between male and female patients with OSAHS. The old age， depressive emotion and more physical symptoms of male patients can predict worse subjective sleep quality; more physical symptoms and longer longest apnea hypopnea time of female patients can predict worse subjective sleep quality.

[Key words] Obstructive sleep apnea hypopnea syndrome; Subjective sleep quality; Gender differences; Physical symptoms

阻塞性睡眠呼吸暂停低通气综合征（Obstructive sleep apnea hypopnea syndrome，OSAHS）是常见的睡眠障碍相关呼吸疾病，患者常有打鼾、憋醒、睡眠效率降低、白天嗜睡等症状。由于OSAHS造成慢性间歇低氧、二氧化碳潴留等，可引发或加重心脑血管疾病及代谢紊乱，也是引起猝死、道路交通事故的重要原因[1]。在我国OSAHS的患病率约3.93%，50～59岁高发，且男性多于女性[2]。目前公认治疗OSAHS最有效的方法是持续气道正压通气（Continuous positive airway pressure，CPAP）。但临床上常见OSAHS患者共病失眠，且该失眠症状并非继发与夜间缺氧而是原发症状，这会导致患者CPAP治疗依从性下降[3]。此外，在OSAHS患者中，影响生活质量的是主观睡眠质量而非呼吸暂停低通气指数（Apnea hypopnea index，AHI）[4]。本研究通过比较男女性OSAHS患者主观睡眠质量的差异及其影响因素，为临床上提高CPAP依从性及患者生活质量提供指导，现报道如下。

1 资料与方法

1.1 一般资料

被试来源于2019年1月至2020年5月至我院睡眠障碍科就诊并行整夜多导睡眠监测（Polysomnography，PSG）的患者。纳入标准：①符合睡眠障碍国际分类第3版[5]中成人阻塞性睡眠呼吸暂停的诊断标准。②年龄18岁以上;③小学及以上文化程度，能完成量表评估[6]。排除标准：①目前正在接受CPAP治疗的患者;②合并重大躯体疾病的患者，如慢性阻塞性肺疾病;③合并重性精神疾病的患者，如精神分裂症;④其他情况：如行便携式多导睡眠监测、监测时间不足7 h、资料不全者等[7]。……