鼻部症状与阻塞性睡眠呼吸暂停患者的主观睡眠损害及症状感知独立相关：一项基于耳鼻咽喉科的队列研究
Nasal symptoms are independently associated with subjective sleep impairment and symptom awareness in obstructive sleep apnea: an otolaryngology-based cohort study.
文献信息
| PMID | 42966800 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yukiyoshi Hyo |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Kawasaki Medical School, 577 Matsushima,, Kurashiki, Okayama, 701-0192, Japan. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 鼻部疾病在阻塞性睡眠呼吸暂停（OSA）中常见。我们此前曾报告，在未进行多变量校正的非肥胖OSA患者中，鼻部症状与睡眠损害存在关联。本研究在基于耳鼻咽喉科的队列中检验鼻部症状是否与主观睡眠质量独立相关，并描述不一致表型。
方法： 这项回顾性研究纳入628例OSA患者（AHI≥5次/小时）。鼻部症状采用JRQLQ评估。睡眠质量采用ESS、AIS和PSQI测量。不一致定义为AHI≥30次/小时但缺乏主观损害（ESS≤10、AIS≤5或PSQI≤5）。
结果： 所有问卷评分均随鼻部症状严重程度而恶化（均p<0.001），而多导睡眠图参数无差异。鼻部症状评分与ESS≥11（OR 1.159）、AIS≥6（OR 1.163）和PSQI≥6（OR 1.247；均p<0.001）独立相关；AHI无统计学意义。校正后，鼻塞对AIS≥6和PSQI≥6仍具有统计学意义。客观鼻阻力与症状不相关（r=-0.022）。按ESS定义，不一致存在于63.0%的患者中，在年龄≥75岁者中升至90.3%。鼻部症状评分与所有定义下的不一致相关（OR 0.755-0.871；均p≤0.027）；AHI无统计学意义。
结论： 在OSA中，鼻部症状与主观睡眠损害独立相关，且超出多导睡眠图定义的严重程度。日间鼻测压不能反映鼻部症状或睡眠质量。大多数重度OSA患者缺乏感知到的损害；鼻部症状负担是唯一与不一致持续相关的因素。建议进行多维度的鼻部与睡眠评估。
英文摘要
PURPOSE: Nasal disorders are common in obstructive sleep apnea (OSA). We previously reported an association between nasal symptoms and impaired sleep in non-obese OSA patients without multivariate adjustment. This study examined whether nasal symptoms are independently associated with subjective sleep quality and characterized the discordance phenotype in an otolaryngology-based cohort.
METHODS: This retrospective study included 628 OSA patients (AHI ≥ 5 events/h). Nasal symptoms were assessed using the JRQLQ. Sleep quality was measured by the ESS, AIS, and PSQI. Discordance was defined as AHI ≥ 30 events/h with absent subjective impairment (ESS ≤ 10, AIS ≤ 5, or PSQI ≤ 5).
RESULTS: All questionnaire scores worsened with nasal symptom severity (all p < 0.001), whereas polysomnographic parameters did not differ. Nasal symptom score was independently associated with ESS ≥ 11 (OR 1.159), AIS ≥ 6 (OR 1.163), and PSQI ≥ 6 (OR 1.247; all p < 0.001); AHI was non-significant. Nasal obstruction retained significance for AIS ≥ 6 and PSQI ≥ 6 after adjustment. Objective nasal resistance did not correlate with symptoms (r = - 0.022). Discordance was present in 63.0% by ESS, rising to 90.3% at age ≥ 75 years. Nasal symptom score was associated with discordance across all definitions (OR 0.755-0.871; all p ≤ 0.027); AHI was non-significant.
CONCLUSIONS: Nasal symptoms are independently associated with subjective sleep impairment in OSA beyond polysomnography-defined severity. Daytime rhinomanometry does not reflect nasal symptoms or sleep quality. Most patients with severe OSA lacked perceived impairment; nasal symptom burden was the only factor consistently associated with discordance. Multidimensional nasal and sleep assessment is recommended.