睡眠前后呼出气一氧化氮水平变化与OSAHS严重程度关系的临床研究

王文娟; 黄礼年; 许启霞; 夏雪梅; 芮艳; 庞颖颖; 庞青

doi:10.16766/j.cnki.issn.1674-4152.002220

睡眠前后呼出气一氧化氮水平变化与OSAHS严重程度关系的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002220

蚌埠医学院第一附属医院肺功能室，安徽蚌埠 233004

基金项目:

国家自然科学基金项目 81600452

蚌埠医学院自然科学基金 BYKY18602D

详细信息

通讯作者:
黄礼年，E-mail：bbmchln@126.com

中图分类号: R56 R443.6
计量
- 文章访问数: 314
- HTML全文浏览量: 125
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-21
- 网络出版日期: 2022-03-02

Clinical study on the relationship between the changes of fractional exhaled nitric oxide and the severity of OSAHS before and after sleep

Pulmonary Function Room, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的初步探讨睡眠前后呼出气一氧化氮(eNO)水平变化在评估阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疾病严重程度中的价值。方法选取2018年11月—2019年10月在蚌埠医学院第一附属医院确诊为OSAHS的患者48例为OSA组，招募62例健康者为对照组。比较2组睡眠前后eNO水平(包括FnNO、FeNO及CaNO)。分析OSA组睡眠前后eNO差值与呼吸暂停低通气指数(AHI)之间的相关性。结果 OSA组睡前FnNO为(468.78±117.19)μg/L、睡后FnNO为(479.21±130.57)μg/L，高于对照组[(371.52±130.21)μg/L、(379.10±129.65)μg/L，均P < 0.05]；OSA组睡前FeNO为(23.10±15.19)μg/L、睡后FeNO为(24.92±14.94)μg/L，高于对照组[(17.71±7.01)μg/L、(18.03±6.63)μg/L，均P < 0.05]。OSA组睡前CaNO水平略低于对照组，差异无统计学意义；OSA组睡后CaNO[(2.88±1.41)μg/L]低于对照组[(4.07±1.86)μg/L，P < 0.05]。2组睡眠前后的FnNO、FeNO水平变化差异均无统计学意义，OSA组睡后CaNO[(2.88±1.41)μg/L]低于睡前[(3.86±1.40)μg/L，P < 0.05]。Spearman相关性分析提示OSA组中CaNO睡眠前后的变化差值(△CaNO)与AHI呈正相关(r=0.384，P=0.008)。依据AHI进行分层后提示，重度OSAHS患者睡后CaNO水平显著降低。结论与睡前比较，轻中度OSAHS患者睡后CaNO水平下降不明显，而重度患者下降较为明显，且△CaNO与AHI显著相关，提示CaNO可以评估OSAHS严重程度。
- 阻塞性睡眠呼吸暂停低通气综合征 /
- 部分呼出气一氧化氮 /
- 肺泡呼出气一氧化氮 /
- 呼吸暂停低通气指数
Abstract: Objective To explore the clinical value of changes of fractional exhaled nitric oxide (eNO) levels before and after sleep in evaluating the disease severity of patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of 48 patients diagnosed with OSAHS from November 2018 to October 2019 in the First Affiliated Hospital of Bengbu Medical College were selected as OSA group, 62 healthy people were recruited as the control group. The pre-sleep and post-sleep levels of eNO [including nasal exhaled NO (FnNO), upper airway exhaled NO (FeNO) and alveolar exhaled NO (CaNO)] were compared between the two groups. The correlation between the changes of eNO and apnea hypopnea index (AHI) in OSA group was analyzed. Results The pre-sleep level of FnNO [(468.78±117.19) μg/L] and the post-sleep level of FnNO [(479.21±130.57) μg/L] in the OSA group were higher than that in the control group[(371.52±130.21) μg/L, (379.10±129.65) μg/L, all P < 0.05]. The pre-sleep level of FeNO [(23.10±15.19) μg/L] and the post-sleep level of FeNO [(24.92±14.94) μg/L] in the OSA group were higher than that in the control group[(17.71±7.01) μg/L, (18.03±6.63) μg/L, all P < 0.05]. The pre-sleep level of CaNO in OSA group was slightly lower than that in the control group, the difference was not statistically significant. The post-sleep level of CaNO [(2.88±1.41) μg/L] in the OSA group was lower than that in the control group [(4.07±1.86) μg/L, P < 0.05]. Compared with pre-sleep, there were no significant differences in post-sleep levels of FeNO and FnNO in both groups, while the post-sleep level of CaNO [(2.88±1.41) μg/L] in the OSA group was significantly lower than that in pre-sleep [(3.86±1.40) μg/L].Spearman correlation analysis showed that there was a significant correlation between the changes of CaNO (△CaNO) and AHI (r=0.384, P=0.008). After stratification according to AHI, the level of CaNO significantly decreased in patients with severe OSAHS after sleep. Conclusion Compared with pre-sleep, the post-sleep level of CaNO is slightly decreased in patients with mild and moderate OSAHS, but significantly decreased in severe patients, and the change of CaNO is significantly correlated with AHI, suggesting that CaNO can evaluate the severity of OSAHS.
- Obstructive sleep apnea hypopnea syndrome /
- Fractional exhaled nitric oxide /
- Alveolar exhaled nitric oxide /
- Apnea hypopnea index

HTML全文

表 1 2组研究对象基线资料比较

组别	例数	性别(例)		年龄 (x±s，岁)	身高 (x±s，cm)	体重 (x±s，kg)	BMI (x±s)	ESS评分 (x±s，分)	颈围 (x±s，cm)
组别	例数	男性	女性	年龄 (x±s，岁)	身高 (x±s，cm)	体重 (x±s，kg)	BMI (x±s)	ESS评分 (x±s，分)	颈围 (x±s，cm)
OSA组	48	26	22	47.41±13.02	164.42±9.57	75.08±14.94	27.87±4.18	8.42±4.87	39.10±3.81
对照组	62	33	29	45.71±13.85	165.45±7.56	70.45±13.67	25.78±4.96	4.95±2.68	36.37±3.59
统计量		0.010^a		0.674^b	-0.616^b	1.692^b	2.347^b	4.751^b	3.857^b
P值		0.922		0.502	0.540	0.093	0.021	< 0.001	< 0.001
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组研究对象睡眠前后FnNO水平比较(x±s，μg/L)

组别	例数	睡眠前FnNO	睡眠后FnNO	t值	P值
OSA组	48	468.78±117.19	479.21±130.57	-0.749	0.458
对照组	62	371.52±130.21	379.10±129.65	-1.316	0.193
t值		4.191	4.004
P值		< 0.001	< 0.001

下载: 导出CSV

表 3 2组研究对象睡眠前后FeNO水平比较(x±s，μg/L)

组别	例数	睡眠前FeNO	睡眠后FeNO	t值	P值
OSA组	48	23.10±15.19	24.92±14.94	-1.580	0.121
对照组	62	17.71±7.01	18.03±6.63	-0.640	0.525
t值		2.279	2.981
P值		0.026	0.004

下载: 导出CSV

表 4 2组研究对象睡眠前后CaNO水平比较(x±s，μg/L)

组别	例数	睡眠前CaNO	睡眠后CaNO	t值	P值
OSA组	48	3.86±1.40	2.88±1.41	5.562	<0.001
对照组	62	4.14±1.67	4.07±1.86	0.499	0.620
t值		-0.921	-3.710
P值		0.359	< 0.001

下载: 导出CSV

表 5 根据AHI水平分层后OSA组患者睡眠前后CaNO水平比较(x±s，μg/L)

组别	例数	睡眠前CaNO	睡眠后CaNO	t值	P值
AHI＜30次/h	23	4.01±1.28	3.72±1.29	2.069	0.051
AHI≥30次/h	25	3.72±1.51	2.10±1.02	6.324	<0.001
t值		0.715	4.846
P值		0.479	＜0.001

下载: 导出CSV

参考文献(21)

[1]	HEINZER R, VAT S, MARQUES-VIDAL P, et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study[J]. Lancet Respir Med, 2015, 3(4): 310-318. doi: 10.1016/S2213-2600(15)00043-0
[2]	中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi: 10.3760/cma.j.issn.0376-2491.2018.24.003
[3]	BIKOV A, LOSONCZY G, KUNOS L, et al. Role of lung volume and airway inflammation in obstructive sleep apnea[J]. Respir Investig, 2017, 55(6): 326-333. doi: 10.1016/j.resinv.2017.08.009
[4]	NUNES J O F, APOSTOLICO J S, ANDRADE D A G, et al. Sleep deprivation predisposes allergic mice to neutrophilic lung inflammation[J]. J Allergy Clin Immunol, 2018, 141(3): 1018-1027. doi: 10.1016/j.jaci.2017.06.025
[5]	JI L, LIU Y, LIU P, et al. Serum periostin and TNF-α levels in patients with obstructive sleep apnea-hypopnea syndrome[J]. Sleep Breath, 2020, 25(1): 331-337.
[6]	张炜, 孙丽丹, 王利菊, 等. 稳定期COPD、OSAHS及重叠综合征患者间呼出气一氧化氮水平差异及n CPAP治疗的影响[J]. 大连医科大学学报, 2018, 40(5): 424-426, 433. https://www.cnki.com.cn/Article/CJFDTOTAL-DLYK201805009.htm
[7]	周燕宁, 彭丽慈, 刘琰, 等. 阻塞性睡眠呼吸暂停低通气综合征患者呼出气一氧化氮水平与认知功能的相关性研究[J]. 临床内科杂志, 2017, 34(1): 29-31. doi: 10.3969/j.issn.1001-9057.2017.01.009
[8]	PIJNENBURG M W. The role of FeNO in predicting asthma[J]. Front Pediatr, 2019, 21(7): 41.
[9]	TSANG K W, IP S K, LEUNG R, et al. Exhaled nitric oxide: The effects of age, gender and body size[J]. Lung, 2001, 179(2): 83-91. doi: 10.1007/s004080000050
[10]	ANTOSOVA M, BENCOVA A, PSENKOVA A, et al. Exhaled nitric oxide-circadian variations in healthy subjects[J]. Eur J Med Res, 2009, 14 Suppl 4(Suppl 4): 6-8.
[11]	ZHANG D, XIAO Y, LUO J, et al. Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea[J]. Sleep Breath, 2019, 23(3): 785-793. doi: 10.1007/s11325-018-1760-1
[12]	DUARTE R L M, RABAHI M F, OLIVEIRA-E-Sá T S, et al. Fractional exhaled nitric oxide measurements and screening of obstructive sleep apnea in a sleep-laboratory setting: A cross-sectional study[J]. Lung, 2019, 197(2): 131-137. doi: 10.1007/s00408-018-0190-y
[13]	HAMADA S, TATSUMI S, KOBAYASHI Y, et al. Nasal nitric oxide improved by continuous positive airway pressure therapy for upper airway inflammation in obstructive sleep apnea[J]. Sleep Breath, 2016, 21(2): 405-410.
[14]	DUONG-QUY S, HUA-HUY T, TRAN-MAI-THI H T, et al. Study of exhaled nitric oxide in subjects with suspected obstructive sleep apnea: A pilot study in vietnam[J]. Pulm Med, 2016, 2016: 3050918.
[15]	李权恒, 李金英, 田文秋, 等. 6岁及以上哮喘儿童呼出气一氧化氮与血嗜酸性粒细胞、肺功能的相关性分析[J]. 中华全科医学, 2016, 14(2): 248-250. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201602031.htm
[16]	CHEN R, SMITH S G, SALTER B, et al. Allergen-induced increases in sputum levels of group 2 innate lymphoid cells in subjects with asthma[J]. Am J Respir Crit Care Med, 2017, 196(6): 700-712. doi: 10.1164/rccm.201612-2427OC
[17]	RHA M S, KIM C H, YOON J H, et al. Association between the neutrophil-to-lymphocyte ratio and obstructive sleep apnea: A meta-analysis[J]. Sci Rep, 2020, 10(1): 10862. doi: 10.1038/s41598-020-67708-w
[18]	KRUZLIAK P, MARUYAMA J, MARUYAMA K, et al. Role of nitric oxide in pathophysiology and treatment of pulmonary hypertension[J]. Vitam Horm, 2014, 96: 407-424.
[19]	CANINO B, HOPPS E, CALANDRINO V, et al. Nitric oxide metabolites and erythrocyte deformability in a group of subjects with obstructive sleep apnea syndrome[J]. Clin Hemorheol Microcirc, 2015, 59(1): 45-52. doi: 10.3233/CH-141815
[20]	OYAMA J, NAGATOMO D, YOSHIOKA G, et al. The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea[J]. J Cardiol, 2016, 67(3): 295-302. doi: 10.1016/j.jjcc.2015.06.005
[21]	ITO Y, AHMAD A, KEWLEY E, et al. Hypoxia-inducible factor regulates expression of surfactant protein in alveolar type Ⅱ cells in vitro[J]. Am J Respir Cell Mol Biol, 2011, 45(5): 938-945. doi: 10.1165/rcmb.2011-0052OC