Journal of Shandong University (Medical Edition):2007,45(1) Quality of life analysis of patients with obstructive sleep apnea hypopnea syndrome (OS-AHS) Zhang Xiaowen, Cai Xiaolan, Pan Xinliang, Lei Dapeng, Liu Dayu, Department of Otorhinolaryngology, Qilu Hospital of Shandong University (Department of Otorhinolaryngology and Head & Neck Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China) [Abstract] Objective: To analyze the quality of life and the factors affecting the quality of life of patients with obstructive sleep apnea hypopnea syndrome (OS-AHS). OBJECTIVE: To analyze the quality of life of patients with obstructive sleep apnea hypopnea syndrome (OS-AHS) and its related influencing factors. METHODS: The Calgary Sleep Apnea Disease-Specific Quality of Life Questionnaire and Epworth Sleepiness Scale (ESS) were used to evaluate the quality of life and excessive daytime sleepiness (EDS) in patients with OSAHS and patients with simple snoring. slepiness (EDS), comparing the differences of each index between OSAHS patients and simple snoring patients, and analyzing the Calgary sleep apnea quality of life index (SAQLI) with body mass index, neck circumference, and abdominal circumference of OSAHS patients by Pearson correlation, Sleep structure, respiratory disorders, EDS, etc. The correlation between the Calgary sleep apnea quality of life index (SAQLI) and body mass index, neck circumference, abdominal circumference, sleep structure, respiratory disorders, EDS, etc., were analyzed by multiple stepwise regression analysis to explore the influencing factors of the quality of life of OSAHS patients. RESULTS: There were differences in the SAQLI and other indicators between patients with OSAHS and patients with simple snoring, and the quality of life of patients with OSAHS had no correlation with body mass index, neck circumference, abdominal circumference, sleep structure, and respiratory disorders, and was correlated with EDS. Multiple stepwise regression analysis showed that EDS was an independent predictor of quality of life in OSAHS patients. CONCLUSION: The quality of life of patients with OSAHS was significantly lower than that of patients with snoring alone, and EDS was an important influence on the quality of life of patients with OSAHS. [Keywords] Sleep apnea, obstructive; quality of life; excessive daytime sleepiness Obstructivesleep apnea hypopnea syndrome (OSAHS) is a common sleep apnea disorder, in which patients suffer from apnea and hypoventilation due to recurrent collapsing obstruction of the upper airway that occurs during sleep OSAHS is a common sleep apnea disorder in which patients suffer from apnea and hypoventilation due to repeated upper airway collapse and obstruction during sleep, and frequent decreases in oxygen saturation, leading to sleep structure disorders, daytime sleepiness, and other conditions.The study of the quality of life of patients with OSAHS has attracted more attention in recent years, and it has become a reliable indicator of changes in the patients’ somatic, psychological, and social functioning, but in the past, the evaluation of the quality of life of patients with OSAHS has mostly used the generalized scale, a 36-item questionnaire short form questionnaire of the U.S. medical outcomes survey ( medical outcomes survey short form questions, SF-36). In this study, the Calgary Sleep Apnea Disease-Specific Quality of Life Questionnaire Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) were used to compare the quality of life of OSAHS patients with that of simple snoring patients, and to compare the quality of life of OSAHS patients with that of simple snoring patients. In order to compare the differences between OSAHS patients and simple snoring patients, we analyzed the correlation between body mass index (BMI), neck circumference, abdominal circumference, sleep structure, respiratory disorders, excessive daytime slepiness (EDS) and quality of life, and the factors influencing the quality of life, with the aim of providing a reliable means of evaluation for clinical research. Data and Methods 1.1 Clinical data 45 patients underwent PSG monitoring in the Department of Otorhinolaryngology, Qilu Hospital, Shandong University, from January to October 2006, because of snoring during sleep, and they did not receive any relevant treatment before the consultation. There were 40 males and 5 females, according to the diagnostic criteria of Hangzhou OSAHS H. Among them, there were 33 cases of os.AHS patients and 12 cases of simple snoring. Age 18-62 years old, the average is (40.95±9.98) years old, BMI 20.96~34.64 kg/m2, the average is (27.59±3.48) kg/m2; neck circumference (the plane of the laryngeal node) 30~47.3 cm, the average is (39.87±3.97) cm; abdominal circumference (the circumference of the two sides of the abdomen through the lower edge of the arch of the ribs and the anterior superior iliac crest between the mid-point of the abdomen to the convex point) 84~12.3 cm; abdominal circumference (both via the lower edge of the rib arch and the anterior superior iliac ridge) 84~12.0 cm. The abdominal circumference (the circumference from the midpoint between the arch edge of the ribs and the anterior superior iliac crest to the most convex point of the abdomen on both sides) ranged from 84 to 125 cm, with an average of (101.39–10.15) cm. 45 patients were excluded from chronic obstructive pulmonary disease, malignant tumors, autoimmune disorders, epilepsy, and other major illnesses that might affect the quality of life.1.2 PSG monitoring45 patients received standardized recordings of electroencephalography, electromyography, oculomotorography, and electrodiagrams on an Icelandic EMBLA PSG monitor from Icelandic flaga, Electromyography, oculomotor electromyography, oro-nasal airflow, snoring, thoracic and abdominal respiratory activity, oxygen saturation, etc., and the whole night sleep monitoring time was more than 7 h. Apnea is defined as the cessation of the oro-nasal airflow during sleep for ≥10 S, and hypoventilation is defined as the reduction of the intensity of respiratory airflow by more than 50% compared with the basal level during sleep, accompanied by the decrease of arterial oxygen saturation (SaO2) by ≥4%. osaHS OSAHS was judged on the basis of the degree of disease: apnea hy．popnea index (AHI) 5-20 was mild, 20-40 was moderate, and >40 was severe, among which 7 cases were mild, 8 cases were moderate, and 18 cases were severe. According to the 1968 Rechtschafen & Kales sleep staging criteria, sleep was categorized into (i) non-rapid eye movement sleep (NREM), including S1, S2, S3, and S4, with S1 and S2 defined as light sleep, and S3 and S4 as deep sleep; and (ii) rapid eye movement sleep (REM).1.3 Evaluation of the patients’ using the specific quality of life questionnaire and ESS Quality of life and EDS All patients were instructed to complete the scales, including the Calgary Sleep Apnea Disease-Specific Quality of Life Questionnaire and ESS, and calculate the Calgary Slep Apnea Quality of Life Index (the Calgary Slep Quality of Life Index, SAQLI) and the EDS scores, prior to doing PSG monitoring. The Calgary Slep Apnea Quality of Life Index (SAQLI) and EDS scores were calculated.The Calgary Slep Apnea Quality of Life Inventory is a specialized quality of life scale for patients with sleep apnea disorders, which includes four dimensions: daily activities, social interactions, emotions, and symptoms. Patients are instructed by a specialized physician to rate each question on 7 levels, and the total score for each section is divided by the total number of respective entries to obtain a score for each section. The total score of the scale was the average of the 4 parts, with the higher the score, the higher the associated quality of life, ranging from 1 to 7. The ESS was used to evaluate EDS by asking patients to evaluate the quality of life in 8 situations according to their own situation in the last few months (while sitting and reading, while watching TV, while sitting inactive in public places such as a meeting, while traveling by car for a duration of 1h without a break, while taking a short break in bed in the afternoon when conditions permit, while sitting and talking with others, while sitting quietly after lunch, and while sitting in the car in the afternoon when the patient is in the car. When reading, sitting quietly after lunch, the need for highly concentrated work intervals) the possibility of dozing off, 0 points: never drowsy, 1 points: sometimes drowsy, 2 points: often drowsy, 3 points: definitely drowsy, calculate the total points to evaluate the degree of drowsiness. 1.4 Statistical processing using SPSS10.0 statistical software package for statistical analysis, the data are expressed in 4-s, the use of a group design of the two-sample comparison of t-test to compare the two groups. The t-test was used to compare the difference between the two groups, and P<0.05 was regarded as statistically significant; Pearson's correlation analysis was used to explore the degree and direction of correlation between the two factors; and multivariate stepwise regression analysis was used to explore the factors influencing the quality of life of patients with OSAHS. 2 Results 2.1 Comparisons of the indicators between the patients with OSAHS and those with simple snoring are shown in table 1. Table 1 shows that the total score and all parts of SAQLI of OSAHS patients were significantly smaller than those of simple snoring patients (P<0.01), and the BMI, neck circumference, abdominal circumference, EDS, S1+S2 (%) of OSAHS patients were significantly higher than those of simple snoring patients, whereas the minimum oxygen level, average oxygen level, S3+S4 (%), and REM (%) were significantly lower than those of simple snoring patients.2.2 Comparison of SAQLI total score and all parts of SAQLI of OSAHS patients and simple snoring patients The correlation analysis between the total score of SAQLI and each part and each index is shown in Table 2.From Table 2, it can be seen that the total score of SAQLI of OSAHS patients and the social interaction, emotion, and symptom were correlated with the EDS (P<0.05), and there was no significant correlation with the objective indexes, such as BMI, neck circumference, abdominal circumference, and the various parameters of PSG. Table 1 Comparative results of each index between patients with simple snoring and patients with OSAHS 2.3 Analysis of the influencing factors of the total SAQLI score and each component in patients with OSAHS Multiple step-by-step regression analysis found that EDS was an influencing factor of the total SAQLI score and social interaction, emotion, and symptom in patients with OSAHS, and the results were as follows: social interaction (r =0.183, P<0.05), emotion (r =0.171, P <0.05), emotion (r =0.171, P <0.05), and symptom (r =0.171, P <0.05). 171, P < 0.05), symptoms (r = 0.167, P < 0.05), and total score (r = 0.132, P < 0.05).3 DISCUSSION OSAHS is a disease with high incidence and potential dangers, and is an independent risk factor for hypertension, coronary heart disease, and cerebrovascular accidents, and has become an important life-threatening disease that has a serious impact on the patients' quality of life. The results of this study showed that the total SAQLI score and all components of OSAHS patients were significantly lower than those of simple snoring patients, and OSAHS reduced the quality of life of patients to a certain extent.OSAHS is characterized by repeated episodes of apnea during sleep, which leads to a decrease in oxygen saturation (see Table 1) and an increase in carbon dioxide. Hypoxia can cause: (1) vasoconstriction, resulting in hypertension; (2) brain damage, resulting in dizziness, memory loss, slow reflection or agitation; (3) cause vagal bradycardia, myocardial ischemia and excitation, inducing heart rate disorders, and even sudden death; (4) stimulate erythrocytes to increase, secondary to erythrocytosis.Repeated awakenings of patients with OSAHS result in fragmentation of sleep, disruption of the structure of sleep (Table 1), increased light sleep, decreased deep sleep, and increased sleepiness of patients with OSAHS. The increase of light sleep and the decrease of deep sleep can lead to: ① daytime sleepiness, fatigue, dizziness, reduced activity, which can lead to or aggravate obesity, and obesity will aggravate the condition of OSAHS; ② cognitive function abnormality and psychiatric disorders, which can be manifested as depression, anxiety, etc.; ③ endocrine disorders related to sleep, such as: growth hormone secretion reduction, sex hormone secretion disorders. Therefore, OSAKS can involve multiple organs throughout the body, thus affecting the quality of life of patients. EDS is one of the main manifestations of OSAHS patients, and with the aggravation of OSAHS, the degree of EDS will also increase, and patients often experience drowsiness at inappropriate times, such as driving, eating, talking with others, attending important meetings and other public activities, which reduces the patient's work efficiency, and even affects the patient's interpersonal and social interactions, thus seriously affecting the quality of life of OSAHS patients. . The results of this study showed that EDS was significantly correlated with the total SAQLI score and each component (except daily life).The results of Akashiba and Kawahara et al. showed that there was no correlation between the quality of life of OSAHS patients and EDS, which seemed to be a contradiction between the two. However, the SF-36 scale used by Akashib and Kawahara et al. to evaluate the quality of life of OSAHS patients, although it has the advantages of a universal scale, also has many shortcomings, for example, the number of questions and the number of reflective choices in the different dimensions of the SF-36 are different, and therefore the same percentage of the different dimensions between the There are also many drawbacks, such as: the number of questions and the number of reflective choices in different dimensions of the SF-36 are different, so that the same percentage change between different dimensions is actually unequal; there are only 2-3 questions in some dimensions, so that the re-testing reliability of these questions is lower compared with dimensions with more questions, and there is also an obvious "ceiling effect"; and, above all, the SF-36 has a low degree of specificity, and there are no questions on sleep quality and daytime sleepiness. Multiple stepwise regression analyses in the present study showed that EDS was an independent predictor of the total SAQLI score and each component (except 13 Life), which is consistent with Akashiba et al.'s study, suggesting that EDS affects health status and quality of life, but only partially predicts changes in quality of life. Both correlation and multiple stepwise regression analyses in this study did not find any correlation between the total SAQLI score and its components and objective monitoring indices such as BMI, neck circumference, abdominal circumference, and each parameter of PSG, which may be due to the fact that OSAHS is a chronic disease that can affect multiple organs in multiple systems of the body caused by a variety of factors, and that patients with OSAHS suffer from somatic and psychiatric symptoms, including metabolic, respiratory, neurologic, and endocrine, cardiovascular system diseases, as well as irritability, depression, mood and cognitive dysfunction, all of which affect the quality of life of patients. Measurement of quality of life is also affected by the subjective psychological factors of patients. OSAHS is a disease that worsens unconsciously, and its harm to the body is slow and gradual; patients are used to the impact of sleep disorders on their quality of life, and the measurement of their quality of life may be inconsistent with the objective condition. In addition, there are certain potential factors that affect the quality of life of OSAHS patients. Therefore, the various factors affecting the quality of life of OSAHA patients need to be further explored in depth, in an effort to provide a reasonable clinical and scientific assessment of the quality of life of OSAHS patients.