Objective:To explore the main influencing factors of excessive daytime sleepiness（EDS） in adults with different degrees of sleep-disordered breathing（SDB）, which will provide the scientific evidences for the individualized diagnosis and treatment. Method:Retrospective analysis was performed on the clinical data of 361 young and middle-aged snoring patients monitored by polysomnography. According to the presence or absence of obstructive sleep apnea（OSA） and apnea hypopnea index（AHI） levels, they were divided into primary snoring（AHI<5）, mild OSA（AHI 5-<15）, moderate OSA（AHI 15-<30） and severe OSA（AHI≥30）. From sleep efficiency（ES）, different sleep stages（REM, NREM1, NREM2, NREM3） ratio of total sleep, oxygen reduction index（ODI）, blood oxygen saturation<90% of total sleep time（TS90%）, the average saturation of blood oxygen（MSaO₂） and the lowest blood oxygen saturation（LSaO₂） of all-night sleep, and AHI in different sleep stages（REM-AHI, NREM-AHI）, MSaO₂ in different sleep stages（REM-MSaO₂, NREM-MSaO₂） and LSaO₂ in different sleep stages（REM-LSaO₂, NREM-LSaO₂）, the main influencing factors of EDS were discussed. Result:Among the 361 patients, 23 patients suffered from the primary snoring, 47 patients with mild OSA, 56 patients with moderate OSA, and 235 patients with severe OSA. REM-AHI, ODI and TS90% in EDS group were 10.9, 9.6 and 0.2 respectively in patients with primary snoring, which were significantly higher than those without EDS（P<0.01）. The main influencing factors of EDS were REM-AHI, ODI, and TS90%. However, among patients with mild OSA, REM-AHI was the main influencing factor of EDS, REM-AHI of the EDS group was 29.6, which was significantly higher than that of the non-EDS（P<0.05）. In patients with moderate OSA, LSaO₂ of the EDS group was 76.2, significantly lower than the group without EDS（P<0.05）, the main influencing factor of EDS is LSaO₂. In patients with severe OSA, BMI, ODI and TS90% in EDS group were significantly higher than those without EDS（P<0.05 or P<0.01）, while NREM-MSaO₂, MSaO₂ and LSaO₂ were significantly lower than those without EDS（P<0.05 or P<0.01）. The main influencing factors of EDS were BMI, NREM-MSaO₂, MSaO₂, LSaO₂, ODI and TS90%. Conclusion:Frequent apnea during REM stage may be one of the important factors causing EDS in patients with primary snoring and mild OSA. For patients with moderate and severe OSA, intermittent hypoxia at night may be the main factor leading to EDS, and obesity may promote the development of the disease and the occurrence of sleepiness.
目的：分析成人不同程度睡眠呼吸紊乱（SDB）患者白天过度嗜睡（EDS）的主要影响因素，为SDB的个性化诊治提供科学依据。 方法：回顾性分析行PSG监测的361例中青年打鼾患者的临床资料，按是否伴有阻塞性睡眠呼吸暂停（OSA）以及AHI水平分为单纯打鼾（AHI<5）、轻度OSA（AHI 5~<15），中度OSA（AHI 15~<30）和重度OSA（AHI≥30），从睡眠效率、不同睡眠分期（REM、NREM1、NREM2、NREM3）占总睡眠比率、氧减指数（ODI）、血氧饱和度<90%时间占睡眠总时间的百分比（TS90%）、整夜睡眠平均血氧饱和度（MSaO₂）和最低血氧饱和度（LSaO₂）以及不同睡眠分期呼吸暂停低通气指数（REM-AHI、NREM-AHI）、不同睡眠分期平均血氧饱和度（REM-MSaO₂、NREM-MSaO₂）和不同睡眠分期最低血氧饱和度（REM-LSaO₂、NREM-LSaO₂）等方面探讨EDS的主要影响因素。 结果：361例患者中，单纯打鼾23例，轻度OSA 47例，中度OSA 56例，重度OSA 235例。单纯打鼾患者中，EDS人群的REM-AHI为10.9、ODI为9.6、TS90%为0.2，均显著高于无EDS人群（P<0.01），EDS的主要影响因素为REM-AHI、ODI和TS90%；但在轻度OSA患者中，EDS人群的REM-AHI为29.6，显著高于无EDS人群（P<0.05），EDS的主要影响因素为REM-AHI；中度OSA患者中，EDS人群的LSaO₂为76.2，显著低于无EDS组（P<0.05），EDS的主要影响因素为LSaO₂；重度OSA患者中，EDS人群的BMI、ODI和TS90%显著高于无EDS人群（P<0.05或P<0.01），而NREM-MSaO₂、MSaO₂和LSaO₂则显著低于无EDS人群（P<0.05或P<0.01），EDS的主要影响因素为BMI、NREM-MSaO₂、MSaO₂、LSaO₂、ODI和TS90%。 结论：REM期频繁发生的呼吸暂停可能是引起单纯打鼾和轻度OSA患者EDS的重要因素之一；而对中重度OSA患者，夜间间歇低氧可能成为导致患者EDS的主要因素，肥胖对病情发展和嗜睡发生有促进作用。.
Keywords: excessive daytime sleepiness; sleep apnea, obstructive; sleep disordered breathing.
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