Study On The Relationship Between TCM Score And Pulmonary Function In Patients With OSA

ObjectiveThe diagnosis and severity of obstructive sleep apnea(OSA)are usually based on apnea hypopnea index(AHI).However,patients with similar severity of AHI have different degrees of pulmonary function injury,which may be related to the anatomical characteristics of individual patients and different severity of nocturnal hypoxia.The TCM(tonsil size,CT90,and MH)scoring system is based on the tonsil size,the vertical distance from the lower margin of the mandible to the hyoid(MH)and the ratio of blood oxygen less than 90% to the total sleep time(CT90).It has been widely used in clinic to predict the curative effect of OSA surgery,and has a higher predictive effectiveness than the traditional scoring system.TCM score has attracted more and more attention in OSA treatment because it combines variables that represent the anatomical(tonsil size and MH)and physiological(CT90)factors of the disease.The purpose of this study was to explore the changes of pulmonary function in patients with OSA and to evaluate the relationship between TCM score and pulmonary function.MethodsTotal of 74 patients with OSA who met the inclusion criteria from January 2021 to October 2022 were collected and divided into low group(n = 27),middle group(n= 14)and high group(n = 33)according to TCM score.Patients were divided into severe and non-severe subgroups according to AHI.According to BMI,patients were divided into three subgroups: normal,overweight and obese.In the subgroup,patients were divided into three subgroups according to TCM score,and finally compared between groups.Collect the factors that may affect the pulmonary function of OSA patients: sex,age,height,weight,AHI,CT90%,MH,tonsil size.The height and weight were calculated as BMI.Statistical analysis was carried out to explore the effects of the above factors on pulmonary function in patients with OSA.Results1.Comparison of pulmonary function indexes in total TCM score group: FEV1 and MMEF75/25% predicted value between groups P > 0.05.There was no significant difference in pulmonary function among low,middle and high groups.The maximal expiratory flow(MEF75,MEF50,MEF25)% predicted values of FVC and forced exhalation of 25,50,75% vital capacity were significantly different between groups(P < 0.05).In the three groups showed that MEF75,MEF50 and MEF25 decreased with the increase of TCM score.2.Comparison of TCM scores in AHI subgroup:(1)Comparison of TCM scores in non-severe OSA patients: Predicted values of FEV1,FVC,MMEF75/25,MEF75,MEF50% between groups,P > 0.05,these changes in lung function indicators were not statistically significant.One second rate(FEV1/FVC)and the predicted value of MEF25% were significantly different between the two groups.(2)Comparison of pulmonary function indexes in TCM group of severe OSA patients: P values of FVC,FEV1,FEV1/FVC,MMEF75/25,MEF75,MEF25% predicted values were all > 0.05,and the changes of pulmonary function indexes were not statistically significant.P value of MEF50% predicted value between groups was < 0.05,and the change was statistically significant.3.Comparison of pulmonary function indexes in BMI subgroup with TCM score:(1)There was no significant difference in the changes of pulmonary function among the groups(P > 0.05).There was no significant difference in lung function.(2)The predicted values of FEV1,FEV1/FVC,MMEF75/25,MEF75,MEF50 and MEF25%in overweight groups were P > 0.05.The changes of these pulmonary function indexes were not statistically significant.The predicted value of FVC% was P < 0.05.The change of pulmonary function index was statistically significant.(3)All the pulmonary function indexes in the obesity group were all P > 0.05.There was no statistical difference in the changes of pulmonary function indexes with different TCM scores in obesity group.4.Analysis of factors affecting pulmonary function in patients with OSA:(1)BMI univariate analysis of variance: the predicted values of MMEF75/25 and MEF25% in non-obese group were higher than those in obese group,P < 0.05.There was significant difference between obese and non-obese patients on pulmonary function in OSA patients.(2)Correlation analysis of other indexes: the correlation coefficients between age and the predicted values of FEV1/FVC and MMEF75/25% were-0.279and-0.235 respectively,P < 0.05.There was a negative correlation.The correlation coefficient between AHI and FEV1% predicted value was 0.234,P < 0.05.There was a negative correlation.The correlation coefficients between MH and the predicted values of FVC,FEV1,MEF75 and MEF50% were-0.28,-0.235,-0.247 and-0.348,respectively.There was no significant linear correlation between CT90,tonsil and pulmonary function in this study.Conclusions1.TCM score combined with some variables of anatomical and physiological factors has a certain application prospect in the prediction of surgical effect.Although it has a certain relationship with the impairment of small airway function,it can not predict the impairment of pulmonary function in OSA.2.BMI,age,AHI and MH are the influencing factors of pulmonary function in patients with OSA,but the degree of explanation for the variation of pulmonary function index is not high,suggesting that more indexes may need to be added to TCM score to establish a predictive model of pulmonary function injury in OSA.