睡眠呼吸障碍综合征及睡眠姿势与屈光参差的关系

The Relationship between Sleep Posture and Anisometropia in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

摘要: 目的：研究探讨阻塞性睡眠呼吸暂停综合征(OSAHS)及不同睡眠姿势与屈光参差的关系。方法：横断面研究，收集在我院呼吸科行多导睡眠监测并确诊为OSAHS的患者61例作为OSA组，年龄匹配的健康人群67例作为对照组，对所有研究对象询问相关个人基本资料及病史，进行眼部检查：电脑验光、角膜地形图及眼轴测定。并根据习惯睡眠姿势将OSA组患者分为侧睡组(OSA-S组)及非侧睡组(OSA-NS组)，对照组分为侧睡组(Control-S组)及非侧睡组(Control-NS组)。分析屈光参差、角膜地形图参数及眼轴长度在各组的差异。结果：OSA组屈光参差发生率为(29/61, 47.54%)高于对照组(11/67, 16.42%) (χ2 = 14.40, P < 0.05)。OSA-S组屈光参差发生率(22/32, 68.75%)分别高于OSA-NS组(7/29, 24.14%)、Control-S (4/24, 16.67%)组和Control-NS (7/43, 16.28%) (χ2 = 12.14, χ2 = 14.96, χ2 = 21.30, all P < 0.05)。轻、中、重度OSAHS屈光参差的发生率分别是20.00%、26.32%、68.75%，重度OSAHS患者屈光参差的发生率最高(重度vs轻度，χ2=3.95，P < 0.05；重度vs中度，χ2 = 6.25，P < 0.05)。角膜地形图检查：OSA组SRI (Surface Regularity Index )、SAI (Surface Asymmetry Index)、CYL (Cylinder)明显高于对照组(t = 82.65, t = 16.65, t = 5.88, all P < 0.05)；OSA-S组侧睡侧眼SRI、SAI、CYL明显高于对侧眼(t = 10.66, t = 2.65, t = 3.47, all P < 0.05)。OSA-S组22名发生屈光参差者侧睡侧眼的眼轴长度大于对侧眼(Z = 1.70, P < 0.05)。结论：习惯单侧睡眠姿势的OSAHS患者，易发生屈光参差，侧睡侧眼近视程度较对侧重，并与OSAHS严重程度相关。

Abstract: Objective: To investigate the occurrence of anisometropia in patients with obstructive sleep apnea syndrome (OSAHS) in different sleeping posture. Methods: Cross-sectional study. Sixty-one patients diagnosed with OSAHS from the Second Affiliated Hospital of Fujian Medical University were sorted as OSA group. Sixty-seven healthy people were recruited as the Control group. All the cases were asked for personal information and medical history, and ophthalmological check-up involved computer optometry, corneal topography, and optical coherence interferometry. The patients in OSA group were divided into side sleeping group (OSA-S group) and non-side sleeping group (OSA-NS group) according to the habitual sleeping posture, and the control group was divided into side sleeping group (Control-S group) and non-side sleeping group (Control-NS group) on the same scenario. The differences in anisometropia, corneal topography parameters and eye axis length were analysed in each group. Results: The incidence of anisometropia in OSA group (29/61, 47.54%) was higher than that in control group (11/67, 16.42%) (χ2 = 14.40, P < 0.05). The incidence of anisometropia in the OSA-S group (22/32, 68.75%) was higher than that in the OSA-NS group (7/29, 24.14%), Control-S (4/24, 16.67%) group, and Control-NS (7/43, 16.28%) (χ2 = 12.14, χ2 = 14.96, χ2 = 21.30, all P < 0.05). The incidences of mild, moderate, and severe OSAHS anisometropia were 20.00%, 26.32%, and 68.75%, respectively. Severe OSAHS patients had the highest incidence of anisometropia (severe vs mild, χ2 = 3.95, P < 0.05; Degree, χ2 = 6.25, P < 0.05). Corneal topographic examination: OSA group SRI (Surface Regularity Index), SAI (Surface Asymmetry Index), CYL (Cylinder) were significantly higher than the control group (t = 82.65, t = 16.65, t = 5.88, all P < 0.05); OSA -The SRI, SAI, and CYL of the sleeping side eye in the S group were significantly higher than that of the contralateral eye (t = 10.66, t = 2.65, t = 3.47, all P < 0.05). In the OSA-S group, 22 patients with anisometropia had a longer axial length than the contralateral eye (Z = 1.70, P < 0.05). Conclusion: Patients with OSAHS who are accustomed to one-sided sleeping posture are prone to anisometropia. The refractive power of the side sleeping eye is higher than that of the contralateral eye and is related to the severity of OSAHS.