粉尘螨抗原滴剂对阻塞性睡眠呼吸暂停低通气综合征合并变应性鼻炎患者经鼻正压通气治疗依从性的影响研究
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摘要
目的探讨粉尘螨抗原滴剂对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom,OSAHS)合并变应性鼻炎(allergic rhinitis,AR)患者经鼻正压通气(nose continuous positive airway pressure,nCPAP)治疗依从性的影响。方法门诊筛选66例同时患有对粉尘螨过敏的持续性AR和中重度OSAHS的且应用nCPAP治疗的成人患者(年龄>18岁),均给予粉尘螨抗原抗过敏正规治疗1年,比较患者治疗前后nCPAP的95%有效使用压力值、每晚nCPAP治疗的时间、在不应用呼吸机时的每小时鼾声指数及嗜睡程度爱泼沃斯嗜睡量表(epworth slepp iness scale,ESS)评分。结果合并粉尘螨抗原阳性AR的中重度OSAHS患者经正规抗过敏治疗后,患者使用nCPAP的95%有效压力值,由(12.76±3.68)cmH_2O降至治疗后的(8.83±2.62)cmH_2O(P<0.05),每晚使用时间由(4.58±1.69)h增加至(6.83±2.36)h(P<0.05),不用呼吸机状态下每小时鼾声指数由治疗前的(386.67±50.68)次/h降至(268.82±32.58)次/h(P<0.05),嗜睡程度ESS评分由(22.36±1.28)分降至(15.68±1.02)分(P<0.05)。结论粉尘螨抗原滴剂能够降低合并AR的中重度OSAHS患者使用nCPAP的有效压力值,增加其使用时间,改善其鼾声指数,减轻白天嗜睡程度,能够提高患者对nCPAP治疗的依从性。
Objective to investigate the effect of dust mite antigen drops on the compliance of patients with obstructive sleep apnea hypopnea syndrom(OSAHS) with allergic rhinitis(AR)via nose continuous positive airway pressure(nCPAP).Methods 66 adult outpatients(age >18 years old) with persistent AR and moderate or severe OSAHS who suffered from dust mite allergy were screened out and treated with nCPAP. All patients were given regularly antiallergic treatment with dust mite antigen for one year. It was comparing to the 95% effective pressure value of nCPAP before and after treatment, the time of nCPAP treatment every night, and hourly snoring index and sleepiness scale(ESS) during without application of ventilator.Results after regular anti-allergic treatment, 95% effective pressure of nCPAP was decreased from(12.76±3.68)cmH_2O to(8.83±2.62)cmH_2O(P<0.05) after treatment in moderate and severe OSAHS patients with dust mite antigen positive AR, and the use time per night increased from(4.58±1.69)h to(6.83±2.36)h(P<0.05). The snore index per hour without ventilator decreased from(386.67±50.68) times/h before treatment to(268.82±32.58) times/h(P<0.05), and the ESS(Epworth Sleeping Scale, ESS) score decreased from(22.36±1.28)points to(15.68±1.02)points(P<0.05).Conclusion Dust-mite antigen drops can reduce the effective pressure of nCPAP in moderate to severe OSAHS patients with AR, increase the time of use, improve the snoring index, reduce daytime sleepiness, and improve the compliance of patients with nCPAP.
Objective to investigate the effect of dust mite antigen drops on the compliance of patients with obstructive sleep apnea hypopnea syndrom(OSAHS) with allergic rhinitis(AR)via nose continuous positive airway pressure(nCPAP).Methods 66 adult outpatients(age >18 years old) with persistent AR and moderate or severe OSAHS who suffered from dust mite allergy were screened out and treated with nCPAP. All patients were given regularly antiallergic treatment with dust mite antigen for one year. It was comparing to the 95% effective pressure value of nCPAP before and after treatment, the time of nCPAP treatment every night, and hourly snoring index and sleepiness scale(ESS) during without application of ventilator.Results after regular anti-allergic treatment, 95% effective pressure of nCPAP was decreased from(12.76±3.68)cmH_2O to(8.83±2.62)cmH_2O(P<0.05) after treatment in moderate and severe OSAHS patients with dust mite antigen positive AR, and the use time per night increased from(4.58±1.69)h to(6.83±2.36)h(P<0.05). The snore index per hour without ventilator decreased from(386.67±50.68) times/h before treatment to(268.82±32.58) times/h(P<0.05), and the ESS(Epworth Sleeping Scale, ESS) score decreased from(22.36±1.28)points to(15.68±1.02)points(P<0.05).Conclusion Dust-mite antigen drops can reduce the effective pressure of nCPAP in moderate to severe OSAHS patients with AR, increase the time of use, improve the snoring index, reduce daytime sleepiness, and improve the compliance of patients with nCPAP.
引文
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[9] 邹小量,杨枝芳,莫侨,等.舌下含服和皮下注射免疫治疗儿童变应性鼻炎的临床疗效观察[J].中国耳鼻咽喉颅底外科杂志,2014,20(4):319-323.Zou XL,Yang ZF,Mo Q,et al.Clinical observation of sublingual and subcutaneous injection immunotherapy for children with allergic rhinitis [J].Chin J Otorhinolaryngol Skull Base Surg,2014,20(4):319-323.
[10] 聂明荣,陈彦球,周丽枫,等.舌下含服粉尘螨滴剂治疗儿童变应性鼻炎的临床疗效与安全性评估[J].中国耳鼻咽喉颅底外科杂志,2014,20(4):341-344.Nie MR,Chen YQ,Zhou LF,et al.Clinical efficacy and safety evaluation of sublingual drip-containing dust mites in children with allergic rhinitis [J].Chin J Otorhinolaryngol Skull Base Surg,2014,20(4):341-344.
[11] Leger D,Bonnefoy B,Pigearias B,et al.Poor sleep is highly associated with house dust mite allergic rhinitis in adults and children[J].Allergy Asthma Clin Immunol,2017,13:36.
[12] 李颖,李玉杰,于敏,等.变应性鼻炎大鼠鼻黏膜组织中血管细胞黏附因子-1与Eotaxin 的表达及临床意义[J].中国耳鼻咽喉颅底外科杂志,2018,24(1):62-65.Li Y,Li YJ,Yu M,et al.Expressions and clinical significances of vascular cell adhesion molecule-1 and Eotaxin in rat nasal mucosa of allergic rhinitis[J],Chin J Otorhinolaryngol Skull Base Surg,2018,24(1):62-65.
[13] Kiely JL,Nolan P,McNicholas WT.Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis[J].Thorax.2004,59(1):50-55.
[14] 杨晓彬,黄映红,杨震,等.声反射技术在儿童OSAHS患者中的临床研究[J].中国耳鼻咽喉颅底外科杂志,2018,24(1):53-56.Yang XB,Huang YH,Yang Z,et al.Clinical study of acoustic reflection technique in children with OSAHS[J],Chin J Otorhinolaryngol Skull Base Surg,2018,24(1):53-56.
[15] Kim SH,Won HK,Moon SD,et al.Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study[J].PLoS One,2017,12(4):e0176425.
[16] Georgalas C.The role of the nose in snoring and obstructive sleep apnoea:an update[J].Eur Arch Otorhinolaryngol,2011,268(9):1365-1373.
[17] Koinis-Mitchell D,Craig T,Esteban CA,et al.Sleep and allergic disease:A summary of the literature and future directions for research[J].J Allergy Clin Immunol,2012,130(6):1275-1281.
[2] Ryan S,Doherty LS,Nolan GM,et al.Effects of heated humidification and topical steroids on compliance,nasal symptoms,and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure[J].J Clin Sleep Med,2009(5):422-427.
[3] 张立坤,邵东风,谷彬,等,变应性鼻炎对成人阻塞性睡眠呼吸暂停低通气综合征的影响[J].解放军医学院学报,2015,36(11):1106-1108,1121.Zhang LK,Shao DF,Gu B,et al.Effect of allergic rhinitis on adult obstructive sleep apnea hypopnea syndrome[J].Academic Journal of Chinese Pla Medical School,2015,36(11):1106-1108,1121.
[4] 姜涛,郭颖,李宪华.阻塞性睡眠呼吸暂停低通气综合征患者性别差异分析[J].中国耳鼻咽喉颅底外科杂志,2012,18(3):183-185.Jiang T,Guo Y,Li XH.Analysis of gender differences in patients with obstructive sleep apnea hypopnea syndrome [J].Chin J Otorhinolaryngol-Skull Base Surg,2012,18(3):183-185.
[5] Michels Dde S,Amanda da Mota Silveira Rodrigues Ada M,Nakanishi M,et al.Nasal involvement in obstructive sleep apnea syndrome[J].Int J Otolaryngol,2014,12(8):171-174.
[6] 张良.变应性鼻炎与非变应性鼻炎与阻塞性睡眠呼吸暂停低通气综合征的关系[J].天津医药,2015,43(9):1015-1018.Zhang L.The relationship between allergic,non-allergic rhinitis and obstructive sleep apnea hypopnea syndrome[J].Tianjin Medical Journal,2015,43(9):1015-1018.
[7] 伍慧卿,赵晓明,林丽莉,等.变应性鼻炎检测方法的对比研究[J].中国耳鼻咽喉颅底外科杂志,2014,20(5):397-402.Wu HQ,Zhao XM,Lin LL,et al.Comparative study on detection methods of allergic rhinitis [J].Chin J Otorhinolaryngol Skull Base Surg,2014,20(5):397-402.
[8] 杨扬,张杰,陈敏,等.变应性鼻炎对儿童阻塞性睡眠呼吸暂停低通气综合征的影响[J].山东大学耳鼻喉眼学报,2015,29(3):6-8,12.Yang Y,Zhang J,Chen M,et al.Effect of allergic rhinitis on obstructive sleep apnea hypopnea syndrome in children[J].Journal of Otolaryngology and Ophthalmology of Shandong University,2015,29(3):6-8,12.
[9] 邹小量,杨枝芳,莫侨,等.舌下含服和皮下注射免疫治疗儿童变应性鼻炎的临床疗效观察[J].中国耳鼻咽喉颅底外科杂志,2014,20(4):319-323.Zou XL,Yang ZF,Mo Q,et al.Clinical observation of sublingual and subcutaneous injection immunotherapy for children with allergic rhinitis [J].Chin J Otorhinolaryngol Skull Base Surg,2014,20(4):319-323.
[10] 聂明荣,陈彦球,周丽枫,等.舌下含服粉尘螨滴剂治疗儿童变应性鼻炎的临床疗效与安全性评估[J].中国耳鼻咽喉颅底外科杂志,2014,20(4):341-344.Nie MR,Chen YQ,Zhou LF,et al.Clinical efficacy and safety evaluation of sublingual drip-containing dust mites in children with allergic rhinitis [J].Chin J Otorhinolaryngol Skull Base Surg,2014,20(4):341-344.
[11] Leger D,Bonnefoy B,Pigearias B,et al.Poor sleep is highly associated with house dust mite allergic rhinitis in adults and children[J].Allergy Asthma Clin Immunol,2017,13:36.
[12] 李颖,李玉杰,于敏,等.变应性鼻炎大鼠鼻黏膜组织中血管细胞黏附因子-1与Eotaxin 的表达及临床意义[J].中国耳鼻咽喉颅底外科杂志,2018,24(1):62-65.Li Y,Li YJ,Yu M,et al.Expressions and clinical significances of vascular cell adhesion molecule-1 and Eotaxin in rat nasal mucosa of allergic rhinitis[J],Chin J Otorhinolaryngol Skull Base Surg,2018,24(1):62-65.
[13] Kiely JL,Nolan P,McNicholas WT.Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis[J].Thorax.2004,59(1):50-55.
[14] 杨晓彬,黄映红,杨震,等.声反射技术在儿童OSAHS患者中的临床研究[J].中国耳鼻咽喉颅底外科杂志,2018,24(1):53-56.Yang XB,Huang YH,Yang Z,et al.Clinical study of acoustic reflection technique in children with OSAHS[J],Chin J Otorhinolaryngol Skull Base Surg,2018,24(1):53-56.
[15] Kim SH,Won HK,Moon SD,et al.Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study[J].PLoS One,2017,12(4):e0176425.
[16] Georgalas C.The role of the nose in snoring and obstructive sleep apnoea:an update[J].Eur Arch Otorhinolaryngol,2011,268(9):1365-1373.
[17] Koinis-Mitchell D,Craig T,Esteban CA,et al.Sleep and allergic disease:A summary of the literature and future directions for research[J].J Allergy Clin Immunol,2012,130(6):1275-1281.