睡眠结构参数对阻塞性睡眠呼吸暂停低通气综合征患者嗅觉功能障碍的预测因素研究

A study on the predictive factors of olfactory dysfunction in patients with obstructive sleep apnea hypopnea syndrome based on sleep structure parameters

摘要

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者嗅觉功能障碍与睡眠结构参数的关系，并识别影响嗅觉功能的影响因素，为研究OSAHS多系统损伤提供新视角。方法 采用横断面研究设计，回顾性分析198例于2020年12月1日至2024年6月30日经多导睡眠监测(polysomnography, PSG)诊断为OSAHS的患者资料。使用Sniffin' Sticks嗅觉测试套件评估嗅觉功能，使用PSG记录睡眠结构参数，包括总睡眠时间(total sleep time, TST)、睡眠效率(sleep efficiency, SE)、N3期睡眠百分比(N3%)、快速眼动睡眠百分比(rapid-eye-movement, REM%)、呼吸暂停低通气指数(apnea and hypopnea index, AHI)、最低血氧饱和度(lowest oxygen saturation, LSaO₂)等。采用Pearson及Spearman相关分析探究睡眠结构参数与嗅觉功能的相关性，用多因素Logistic回归，分析各睡眠参数对嗅觉障碍的独立影响。结果 OSAHS患者嗅觉障碍组的男性比例高于嗅觉正常组(P<0.05)；嗅觉障碍组的TST、SE、快速动眼(rapid eye movement, REM)睡眠期微觉醒总次数及非快速动眼(rapid eye movement, NREM)睡眠期微觉醒总次数、N3/TST%、REM/TST%低于嗅觉正常组(P<0.05)；嗅觉障碍组的AHI及入睡后清醒时间(wake after sleep onset, WASO)长于嗅觉正常组(P<0.05)；嗅觉障碍组的嗅觉阈值(threshold, T)、辨别能力(discrimination, D)、识别能力(identification, I)以及嗅觉阈值+辨别能力+识别能力的总分(TDI)均低于嗅觉正常组(P<0.05)。相关分析显示，TDI总分与年龄、AHI、WASO呈负相关，与TST、SE、REM期微觉醒总次数、REM/TST%呈正相关。Logistic回归结果显示，年龄、AHI和REM/TST%是TDI的独立影响因素。结论 年龄增长、AHI升高及REM/TST%降低是嗅觉障碍发生的独立影响因素。嗅觉功能下降与REM睡眠显著减少密切相关。高龄、高AHI及低REM占比的OSAHS患者应作为嗅觉功能筛查的重点人群。

Abstract

Objective The present study aims to explore the relationship between olfactory dysfunction and sleep structure parameters in patients diagnosed with obstructive sleep apnoea hypopnoea syndrome (OSAHS). In addition, the study will seek to identify the predictive factors affecting olfactory function, with a view to providing a new perspective on the study of multi-system damage in OSAHS. Methods A cross-sectional study design was adopted to retrospectively analyze the data of 198 patients diagnosed with obstructive sleep apnea-hypopnea syndrome (OSAHS) through polysomnography (PSG) from December 1, 2020 to June 30, 2024. The Sniffin' Sticks olfactory test kit was used to assess olfactory function, and PSG was employed to record sleep structure parameters, including total sleep time (TST), sleep efficiency (SE), percentage of N3 sleep (N3%), percentage of rapid eye movement sleep (REM%), apnea-hypopnea index (AHI), and lowest oxygen saturation (LSaO₂). Pearson and Spearman correlation analyses were used to explore the correlation between sleep structure parameters and olfactory function. Multivariate logistic regression was applied to analyze the independent influence of each sleep parameter on olfactory impairment. Results The proportion of males and age demographics in the olfactory disorder group of OSAHS patients were higher than those in the normal olfactory group (P<0.05). The total sleep time (TST), sleep efficiency (SE), total number of microarousals in the rapid eye movement (REM) sleep period and non-rapid eye movement (NREM) sleep period, N3/TST%, and REM/TST% in the olfactory disorder group were lower than those in the normal olfactory group (P<0.05). The apnea-hypopnea index (AHI) and wake time after sleep onset (WASO) in the olfactory disorder group were longer than those in the normal olfactory group (P<0.05). The olfactory threshold (Threshold, T), discrimination ability (Discrimination, D), identification ability (Identification, I), and the total score of olfactory threshold + discrimination ability and identification ability (TDI) in the olfactory disorder group were found to be lower than those in the normal olfactory group (P<0.05). A relevant analysis demonstrates a negative correlation between the total score of TDI and age, as well as AHI and WASO. In contrast, a positive correlation is observed between TDI and TST, SE, the total number of micro-awakenings in the REM stage, and REM/TST%. The findings of the logistic regression analysis indicated that age, AHI and REM/TST% were independent factors that influenced TDI. Conclusion Increased age, elevated apnea-hypopnea index (AHI), and decreased proportion of rapid eye movement (REM) sleep (REM/TST%) have been identified as independent influencing factors for olfactory disorders. The decline in olfactory function has been found to be significantly associated with a marked reduction in REM sleep. Patients suffering from obstructive sleep apnoea-hypopnoea syndrome (OSAHS) who are elderly, have a high apnoea hypopnoea index (AHI), and a low proportion of rapid eye movement (REM) sleep should be the key population for olfactory function screening.

关键词

阻塞性睡眠呼吸暂停 / 嗅觉功能 / 睡眠结构 / 影响因素分析

Key words

Obstructive sleep apnea / Olfactory function / Sleep structure / analysis of Influencing factors

参考文献

[1] Li CY, Gao YQ, Huang WJ, et al. The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome: Evidence from a large cross-sectional study [J]. Sleep Med, 2023, 111: 94-100. DOI: 10.1016/j.sleep.2023.09.007

[2] Faria A, Allen AH, Fox N, Ayas N, Laher I. The public health burden of obstructive sleep apnea. Sleep Sci. 2021 Jul-Sep; 14(3): 257-265. DOI: 10.5935/1984-0063.20200111

[3] Léger D, Stepnowsky C. The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea[J]. Sleep Med Rev, 2020, 51: 101275. DOI: 10.1016/j.smrv.2020.101275

[4] Karakurt SE, Karakuş MF, Çolak M, et al. Evaluation of olfactory function in patients with obstructive sleep apnea syndrome[J]. Sleep Breath, 2020, 24(3): 1137-1142. DOI: 10.1007/s11325-019-01996-z

[5] Iannella G, Magliulo G, Maniaci A, et al. Olfactory function in patients with obstructive sleep apnea: a meta-analysis study[J]. Eur Arch Oto Rhino Laryngol, 2021, 278(3): 883-891. DOI: 10.1007/s00405-020-06316-w

[6] 贾怡松, 吕思莹, 白尚杰. 阻塞性睡眠呼吸暂停与嗅觉功能的相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(1): 34-37. DOI: 10.13201/j.issn.2096-7993.2021.01.008

[7] Deguchi K, Doi T, Takata T, et al. Rapid eye movement sleep behavior disorder-like symptoms due to arousal responses associated with severe obstructive sleep apnea-hypopnea[ J]. Intern Med, 2021, 60(11): 1775-1778. DOI: 10.2169/internalmedicine.6218-20

[8] Gauld C, Lopez R, Geoffroy PA, et al. A systematic analysis of ICSD-3 diagnostic criteria and proposal for further structured iteration [ J]. Sleep Medicine Reviews, 2021, 58: 101439. DOI: 10.1016/j.smrv.2021.101439

[9] Howell M, Avidan AY, Foldvary-Schaefer N, et al. Management of REM sleep behavior disorder: an American academy of sleep medicine clinical practice guideline [J]. Journal of Clinical Sleep Medicine, 2023, 19(4): 759-768. DOI: 10.5664/jcsm.10424

[10] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 嗅觉障碍诊断和治疗专家共识(2017年) [J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(7): 484-494. DOI: 10.3760/cma.j.issn.1673-0860.2018.07.002

[11] Dong JJ, Yu X, Liang YZ, et al. Nomogram for predicting olfactory disorder in obstructive sleep apnea: a retrospective study based on a multicenter database[J]. PLoS One, 2025, 20(3): e0318145. DOI: 10.1371/journal.pone.0318145

[12] Liu YF, Fang F, Zhan XJ, et al. The impact of obstructive apnea sleep syndrome on chemic function [ J]. Sleep Breath, 2020, 24(4): 1549-1555. DOI: 10.1007/s11325-020-02022-3

[13] Lee DH, Song J. Impaired olfactory system in metabolic imbalance-related neuropathology[ J]. Life Sci, 2024, 355: 122967. DOI: 10.1016/j.lfs.2024.122967

[14] Ali M, Ramadan A, Surani S. Obstructive sleep apnea-hypopnea syndrome immunological relationship [ J ]. World Journal of Clinical Cases, 2024, 12(27): 6011. DOI: 10.12998/wjcc.v12.i27.6011

[15] Poirrier AL, Eloy P, Rombaux P. Nose and sleep breathing disorders[M] // Nasal Physiology and Pathophysiology of Nasal Disorders. Berlin, Heidelberg: Springer, 2013: 293-311. DOI: 10.1007/978-3-642-37250-6_23

[16] Zhang XP, Zhou H, Liu HJ, et al. Role of oxidative stress in the occurrence and development of cognitive dysfunction in patients with obstructive sleep apnea syndrome[J]. Molecular Neurobiology, 2024, 61(8): 5083-5101. DOI: 10.1007/s12035-023-03899-3

[17] Dai Y, Li XL, Liang SS, et al. MultiChannel Sleep Net: a transformer-based model for automatic sleep stage classification with PSG[J]. IEEE J Biomed Health Inform, 2023, 27(9): 4204-4215. DOI: 10.1109/jbhi.2023.3284160

[18] 高吉, 龚哲, 陈菊萍. 阻塞性睡眠呼吸暂停综合征患者发生嗅觉功能障碍的影响因素分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2021, 29(2): 121-126. DOI: 10.16542/j.cnki.issn.1007-4856.2021.02.010

[19] Dong JJ, Yu X, Liang YZ, et al. Nomogram for predicting olfactory disorder in obstructive sleep apnea: a retrospective study based on a multicenter database[J]. PLoS One, 2025, 20(3): e0318145. DOI: 10.1371/journal.pone.0318145

[20] Boesveldt S, Lindau ST, McClintock MK, et al. Gustatory and olfactory dysfunction in older adults: a national probability study[J]. Rhin, 2011, 49(3): 324-30. DOI: 10.4193/Rhino10.155

[21] Doty RL, Cameron EL. Sex differences and reproductive hormone influences on human odor perception[J]. Physiol Behav, 2009, 97(2): 213-28. DOI: 10.1016/j.physbeh.2009.02.032

[22] Kovalev VA, Kruggel F, von Cramon DY. Gender and age effects in structural brain asymmetry as measured by MRI texture analysis[ J]. Neuroimage, 2003, 19(3): 895-905. DOI: 10.1016/s1053-8119(03)00140-x

[23] Smith KE, Whiteroft K, Law S, et al. Olfactory ensheathing cells from the nasal mucosa and olfactory bulb have distinct membrane properties[J]. J Neurosci Res, 2020, 98(5): 888-901. DOI: 10.1002/jnr.24566

[24] Baeg E, Jedema HP, Bradberry CW. Orbitofrontal cortex is selectively activated in a primate model of attentional bias to cocaine cues[J]. Neuropsychopharmacology, 2020, 45(4): 675-682. DOI: 10.1038/s41386-019-0499-0