摘要
背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病理改变可引起内耳和听觉系统的功能障碍,而关于OSAHS合并高脂血症对这一发生过程的影响暂无定论。目的研究中重度OSAHS患者听觉功能检查特征及其与OSAHS、三酰甘油(TG)的相关性,并探究其可能原因。方法选取2017年1月-2019年5月在上海交通大学医学院附属瑞金医院耳鼻咽喉科住院的中重度OSAHS患者50例,根据患者清晨空腹TG水平分为TG升高OSAHS组(25例)、TG正常OSAHS组(25例),同期选择20例健康体检者为对照组。对研究对象进行纯音听阈测定(PTA)、畸变产物耳声发射(DPOAE)检查,并记录不同频率的听阈值及信噪比(SNR),分析OSAHS患者听觉功能检查特征,探究TG是否加重听力损伤。采用Pearson相关分析探究不同频率的听阈值、SNR与OSAHS患者特征的相关性。结果TG正常OSAHS组PTA的2.00、4.00、8.00 kHz的听阈值及平均听阈值高于对照组(P<0.05),DPOAE的4.00 kHz的SNR低于对照组(P<0.05)。TG升高OSAHS组DPOAE的1.00、2.00、8.00 kHz的SNR低于TG正常OSAHS组(P<0.05)。PTA的0.50 kHz(r=0.227)、1.00 kHz(r=0.362)、2.00 kHz(r=0.328)、4.00 kHz(r=0.403)、8.00 kHz(r=0.463)听阈值及平均听阈值(r=0.500)与年龄呈正相关,1.00 kHz(r=0.333)、2.00 kHz(r=0.372)、4.00 kHz(r=0.464)、8.00 kHz(r=0.330)听阈值及平均听阈值(r=0.399)与呼吸暂停低通气指数(AHI)呈正相关,2 kHz(r=-0.314)听阈值与最低动脉血氧饱和度(SaO2)呈负相关,1.00 kHz(r=0.378)、2.00 kHz(r=0.444)听阈值与TG呈正相关;DPOAE的2.00 kHz(r=-0.221)、4.00 kHz(r=-0.432)、8.00 kHz(r=-0.441)的SNR与年龄呈负相关,4.00 kHz(r=-0.545)、8.00 kHz(r=-0.241)的SNR与AHI呈负相关,1.00 kHz(r=-0.507)、2.00 kHz(r=-0.385)的SNR与TG呈负相关(P<0.05)。结论中重度OSAHS患者有不同程度的听力损伤,中重度OSAHS伴血脂升高则可加重听力损伤。OSAHS越严重,听力损伤越明显。年龄、AHI、TG水平越高,中重度OSAHS患者的听力损伤越严重。
Background Obstructive sleep apnea-hypopnea syndrome(OSAHS)-related pathological changes can lead to dysfunction of the inner ear and auditory system.However,it is not clear whether hyperlipidemia plays a role in this process.Objective To investigate the correlations of auditory function with OSAHS severity and plasma triacylglycerol(TG)and the possible causes in moderate to severe OSAHS patients.Methods 50 inpatients with moderate to severe OSAHS(consisting of 25 normal and 25 elevated morning fasting plasma TG individuals)were recruited from Department of Otolaryngology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2017 to May 2019,and were compared with 20 healthy controls.Pure tone audiometry(PTA)and distortion-product otoacoustic emission(DPOAE)were measured in all participants and hearing threshold and signal-to-noise ratio(SNR)at different frequencies were recorded.Characteristics of auditory function and whether elevated TG was associated with the aggravation of hearing loss in OSAHS patients were analyzed.Pearson correlation analysis was used to explore the correlations of hearing threshold and SNR at different frequencies with characteristics of OSAHS patients.Results Compared with the controls,OSAHS patients with normal TG had higher average hearing threshold of PTA at 2.00 kHz,4.00 kHz,and 8.00 kHz and overall average hearing threshold but lower average SNR of DPOAE at 4.00 kHz(P<0.05).The mean SNR of DPOAE at 1.00 kHz,2.00 kHz and 8.00 kHz in OSAHS patients with elevated TG was lower than that of those with normal TG(P<0.05).The hearing threshold of PTA at 0.50 kHz(r=0.227),1.00 kHz(r=0.362),2.00 kHz(r=0.328),4.00 kHz(r=0.403),and 8.00 kHz(r=0.463),and average hearing threshold(r=0.500)were positively correlated with age.The hearing threshold of 1.00 kHz(r=0.333),2.00 kHz(r=0.372),4.00 kHz(r=0.464),and 8.00 kHz(r=0.330),and average hearing threshold(r=0.399)were positively correlated with AHI.The hearing threshold of 2.00 kHz(r=-0.314)was negatively correlated with the lowest SaO2.The hearing threshold of 1.00 kHz(r=0.378),and 2.00 kHz(r=0.444)was positively correlated with TG.The SNR of DPOAE of 2.00 kHz(r=-0.221),4.00 kHz(r=-0.432)and 8.00 kHz(r=-0.441)was negatively correlated with age,meanwhile the SNR of 4.00 kHz(r=-0.545)and 8.00 kHz(r=-0.241)was negative correlated with AHI.The SNR of 1.00 kHz(r=-0.507)and 2.00 kHz(r=-0.385)was negatively correlated with TG(P<0.05).Conclusion Moderate to severe OSAHS patients have different degrees of hearing loss.Moreover,the hearing loss may be aggravated by elevated blood lipids.The severity of OSAHS increased with the aggravation of hearing loss.Moreover,increased age,AHI and TG were associated with aggravated hearing loss in OSAHS.
作者
李莉
张浩
单雅敏
LI Li;ZHANG Hao;SHAN Yamin(Department of Otolaryngology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中国全科医学》
CAS
北大核心
2021年第5期566-570,共5页
Chinese General Practice
关键词
睡眠呼吸暂停
阻塞性
听觉
纯音听阈测定
畸变产物耳声发射
三酰甘油
Sleep apnea,obstructive
Auditory perception
The pure tone threshold test
Deformed product otoacoustic emission
Triglyceride
