2020 年第 8 期 第 15 卷

阻塞性睡眠呼吸暂停与咽喉反流性疾病的伴发情况及治疗交叉反应

Concomitant situation and therapeutic cross reaction of obstructive sleep apnea and laryngopharyngeal reflux disease

作者：闫素英姚淋尹冯燕军

英文作者：Yan Suying Yao Linyin Feng Yanjun

单位：首都医科大学附属北京安贞医院耳鼻咽喉头颈外科北京市心肺血管疾病研究所100029

英文单位：Department of Otolaryngology-Head and Neck Surgery Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung Blood and Vessel Diseases Beijing 100029 China

关键词：阻塞性睡眠呼吸暂停；喉咽反流性疾病；持续气道正压通气；质子泵抑制剂

英文关键词：Obstructivesleepapnea;Laryngopharyngealrefluxdisease;Continuouspositiveairwaypressure;Protonpumpinhibitor

• 摘要：

• 目的 评估阻塞性睡眠呼吸暂停（OSA）与咽喉反流性疾病（LPRD）的临床伴发状况，探讨持续气道正压通气（CPAP）治疗OSA对LPRD的影响以及质子泵抑制剂（PPI）治疗LPRD对OSA患者症状的改善。方法 选择2019年1—12月就诊于首都医科大学附属北京安贞医院耳鼻咽喉头颈外科的以OSA及LPRD相关症状为主诉的患者109例，依据临床情况最终49例患者纳入OSA并发LPRD的治疗。根据患者睡眠呼吸暂停低通气指数（AHI）值分为轻度OSA组（5≤AHI<15，26例）和中重度OSA组（AHI≥15，23例），轻度OSA组给予生活指导及PPI奥美拉唑治疗，中重度OSA组给予CPAP治疗，2组患者均持续治疗8周。比较治疗前后AHI、反流症状指数(RSI)量表、反流体征量表(RFS)、匹兹堡睡眠质量指数（PSQI）量表评分、最低血氧饱和度等指标变化。观察治疗的不良反应。结果 OSA患者中LPRD发生率为88.9%（64/72），LPRD中OSA发生率为63.4%（64/101）。轻度OSA组PPI治疗后RSI量表、RFS、PSQI量表评分低于PPI治疗前，差异均有统计学意义（均P<0.05）。中重度OSA组CPAP治疗后RSI量表、RFS、PSQI量表评分低于CPAP治疗前，最低血氧饱和度高于CPAP治疗前［（19±6）分比（34±5）分、（13.1±2.9）分比（22.4±3.0）分、（10.2±2.1）分比（15.4±2.9）分、（92±7）%比（82±6）%］，差异均有统计学意义（均P<0.05）。接受PPI治疗的26例患者中2例出现腹胀，5例便秘，7例胃胀气，对症处理后好转；接受CPAP治疗的患者中12例患者不能耐受而中途终止，其余未见明显不适。结论 OSA与LPRD有较高的共存率，临床工作中对于以OSA症状为主诉的患者也应进行LPRD症状的评估；CPAP治疗对LPRD症状有较为明显的改善。

• Objective To assess the clinical concomitant situatio of obstructive sleep apnea(OSA) associated with laryngopharyngeal reflux disease(LPRD), and to evaluate the effect of continuous positive airway pressure(CPAP) treatment of OSA on LPRD and the proton pump inhibitor(PPI) improvement of OSA patients treated with LPRD. Methods From January to December 2019, 109 patients with OSA and LPRD admitted to Beijing Anzhen Hospital, Capital Medical University were selected. According to the clinical situation, 49 patients were included in the treatment of OSA complicated with LPRD. According to the apnea hypopnea index(AHI), the patients were divided into mild OSA group(5≤AHI<15, 26 cases) and moderate and severe OSA group(AHI≥15, 23 cases). The mild OSA group was given life guidance and PPI omeprazole treatment, and the moderate and severe OSA group was given CPAP treatment. Both groups were treated for 8 weeks. The changes of AHI, reflux symptom index(RSI) scale, reflux finding scale(RFS), Pittsburgh sleep quality index(PSQI) scale and the lowest oxygen saturation were compared before and after treatment. The adverse reactions were observed. Results The incidence of LPRD was 88.9%(64/72) in OSA patients and the incidence of OSA was 63.4%(64/101) in LPRD patients. The scores of RSI scale, RFS and PSQI scale in mild OSA group after PPI treatment were lower than those before PPI treatment(all P<0.05). The scores of RSI scale, RFS and PSQI scale in moderate and severe OSA group after CPAP treatment were lower than those before CPAP treatment, and the lowest oxygen saturation was higher than that before CPAP treatment［（19±6） vs （34±5）, （13.1±2.9） vs （22.4±3.0）, （10.2±2.1） vs （15.4±2.9）, （92±7）% vs （82±6）%, all P<0.05］. There were 2 cases with abdominal distension, 5 cases with constipation, 7 cases with flatulence in mild OSA group treated with PPI, they were improved after symptomatic treatment. Twelve patients treated with CPAP were unable to tolerate and stopped midway, while the rest showed no obvious discomfort.Conclusion The co-existence rate of OSA and LPRD is high, so it is necessary to evaluate LPRD symptoms in patients with OSA symptoms. The symptoms of LPRD were significantly improved by CPAP treatment.