Research On TCM's Syndrome Differentiation Of Obstructive Sleep Apnea-Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome(OSAHS)is a very common disease, which is characterized by recurrent apneas caused by occlusion of upper airway during sleep,leading to arterial oxygen desaturation and a decrease in tissue oxygen concentration. Patients with OSAHS exhibit dramatic fragmentation of sleep,a decease in the duration of stage 3 and 4 sleep,decreased percentages of rapid eye movement sleep,and excessive daytime somnolence.The cause and pathogenesis of OSAHS are not clear.Traditional Chinese Medicine has some exerprinces of OSAHS treatment,and literatures make clear that TCM can result in satisfying curative effect of OSAHS.The essence of TCM is determination of treatment based on the syndrome differentiation,the syndrome differentiation is the base of the treatment.So in order to study the TCM therapy of OSAHS,we must study the syndrome differentiation first.As the diagnosis of TCM syndromes and the evaluation of the clinical therapeutic efficiency at present,there is not a common,regular and objective standard system,this current situation makes the clinical curative effect assessment not provid enough evidences.Therefore,it is important to study the normalization and standardization of the syndromes of OSAHS.Part one Research on TCM's syndrome differentiation of OSAHS in adultsSubjects were patients with OSAHS,their ages were over 15 years and they had classic TCM's syndromes.Questionnaire,physical examination,fiber nasopharyngoscop and overnight polysomnography were performed in all patients.The cross section area and the dimension of palate and lingua region upper airway was studied by running image tools software in computer,and the pharynx wall resilience at palate and lingua region upper airway were calculated.Data were analyzed by SPSS12.0.There were five syndromes of TCM in 95 patients with OSAHS.Frequency and ratio of every syndrome:the syndrome of phlegm and heat was 20,the syndrome phlegm and pathogenic wetness was 22,the syndrome of interties phlegm and blood stasis was 19,the syndrome of asthenic splenic was 18,the syndrome of kidney-yang-deficiency was 16.The results showed that age,apnea hyponea index,body mass index,neck collarage,preference for wine or smoking and local conditions were main influencing factors related to the distribution and changes of syndromes.There were some differences between common symptoms and TCM's syndromes.There was some correlation between few local symptoms and TCM's syndromes: patients with phlegm and heat had more yellow purulent rhinorrhea(P＜0.05),patients with kidney-yang-deficiency had more white purulent rhinorrhea(P＜0.05),the epiglottidean fuction of patients with asthenic splenic and kidney-yang-deficiency was weak.The patients with OSAHS were assessed for excessive daytime sleepiness using Epworth sleepiness scale(ESS).The ESS score of patients with phlegm and pathogenic wetness and kidney-yang-deficiency was higher than ones of other three groups,there were statistics significance(P＜0.01,P＜0.05),wich indicates that the patients with phlegm and pathogenic wetness and kidney-yang-deficiency had more chance to get sleepiness.Polysomnography records the sleep course,sleep architecture,arousal index,breath event,blood oxygen and so on.The relationship between the index of polysomnography and TCM's syndromes as fellowing:1.sleep course:The sleep latency of the patients with phlegm and pathogenic wetness and kidney-yang-deficiency decreased obviously(P＜0.01,P＜0.05).No statistical differences were found among the patients with OSAHS's recordings in other sleep parameters(P＞0.05).2.sleep structure The patients with OSAHS has sleep structure disturbance.The light sleep increase obviously,but deep one decrease obviously.The sleep structure is insufficient.StageⅠsleep of the patients with kidney-yang-deficiency was the longest. StageⅡsleep of the patients with kidney-yang-deficiency and the ones with asthenic splenic was longer than others.Slow wave sleep and rapid eye movement had no statistics significance among 5 group patients(P＞0.05).3.arousal index Total arousal index of the patients with OSAHS was higher than the one of primary snoring people(P＜0.01).Total arousal index of the patients with phlegm and pathogenic wetness and the ones with interties phlegm and blood stasis was the highest(P＜0.01).Arousal index of all patients with OSAHS in stage REM had no statistics significance(P＞0.05).The patients with phlegm and pathogenic wetness and the ones with interties phlegm and blood stasis had higher arousal index of stage NREM,arousal index associated with hypopnea,arousal index associated with RDI than others.Arousal index associated with leg movement of the patients with interties phlegm and blood stasis was the highest(P＜0.05).4.breath event Apnea hypopnea index of the patients with interties phlegm and blood stasis was the highes(P＜0.05).The longest hypopnea time of the patients with phlegm and heat was the longest in stage NREM((P＜0.05)and other breath event time of the patients with OSAHS had no statistics significance(P＞0.05).5.blood oxygen No statistical differences were found among the patients with OSAHS's recordings in the lowest SaO2,the mean SaO2 and the percent of the total time with oxygen saturation level＜90%(P＞0.05).Oxygen desaturation index of the patients with kidney-yang-deficiency was the lowest(P＜0.05).Part two Research on TCM's syndrome differentiation of OSAHS in childrenSubjects were patients with OSAHS,their ages were over 3 years and lower 12 years and they had classic TCM's syndromes.Questionnaire,physical examination,endoscopy and overnight polysomnography were performed in all patients.Data were analyzed by SPSS12.0.There were two syndromes of TCM in 29 children patients with OSAHS.Frequency of every syndrome:the syndrome of asthenic splenic was 17,the syndrome of kidney-yin-deficiency was 12.There were found more asthenia syndromes in children patients which maybe beared on children's physiologic and pathologic characteristics. Another cause maybe was that the samples were not enough.The results showed that no statistical differences were found among the patients with OSAHS in sex constitutes,age,apnea hyponea index,disease course and so on(P＞0.05).There were no more different common symptoms between the two groups.Only enuresis and night sweat in the patients with kidney-yin-deficiency were much more than another group(P＜0.05,P＜0.01).Evaluation on accompanying sinusitis and secretory otitis media:children with asthenic splenic was liabal to get secretory otitis and there was statistical differences between the groups(P＜0.05).About the relationship between local symptoms and TCM's syndromes:there were more adenoid gradeⅣin children with asthenic splenic obviously than that in children with kidney-yin-deficiency(P＜0.05).The relationship between the index of polysomnography and TCM's syndromes as fellowing:1.sleep course:The sleep efficiency of the patients with kidney-yin-deficiency was higher than that of the patients with asthenic splenic(P＜0.01).No statistical differences were found among the patients with OSAHS's recordings in other sleep parameters(P＞ 0.05).2.sleep structure The sleep time in stage REM of the two groups patients decreased obviously.But theirs sleep structure had no differences(P＞0.05).3.arousal index Total arousal index of the patients with asthenic splenic was higher than that of the patients with kidney-yin-deficiency(P＜0.05).Spontaneous arousal index of the patients with asthenic splenic was higher than that of the patients with kidney-yin-deficiency(P＜0.01).4.breath event There was no significant distinction beteen asthenic splenic and kidney-yin-deficiency group about apnea hypopnea index(P＞0.05).The apnea index of the patients with kidney-yin-deficiency was higher than that of another patients group in stage NREM and all night sleep(P＜0.05).5.blood oxygen No statistical differences were found between the patients with OSAHS's recordings in the lowest SaO2 and the mean SaO2(P＞0.05).Oxygen desaturation index of the patients with kidney-yang-deficiency was higher than that of the patients with asthenic splenic(P＜0.01).The research found that TCM's syndrome of adult's OSAHS had more excess syndrome than deficiency syndrome and excess syndrome was related to phlegm syndrome. TCM's syndrome of children OSAHS had more deficiency syndrome and almost was related to spleen and kidney.There were statistical differences between few local symptoms and TCM's syndromes,which maybe related to insufficient samples in this research. Differentiation of local syndrome is one important part of TCM's otorhinolaryngology.This research also found that polysomnography using to differentiation of syndrome had some clinical worth.