Abstract: Background　Obstructive sleep apnea-hypopnea syndrome（OSAHS）is a common clinical sleep disorder.The concentration of metabolic hormones and the obesity，a major risk factor for OSAHS，may trigger abnormal sleep-related events in patients with OSAHS，but the causes are still unclear.and there are few studies exploring the relationship of leptin，orexin，and Ghrelin with polysomnography（PSG）parameters in patients with OSAHS.Objective　 To explore the influencing factors of the severity of OSAHS，and the correlation of serum leptin，orexin，Ghrelin and metabolic and PSG parameters in patients with OSAHS.Methods　We enrolled 58 patients with PSG diagnosed OSAHS from December 2017 to December 2018 from the Sleep Medicine Center，Shengjing Hospital of China Medical University.According to the apnea-hypopnea index（AHI），they were divided into mild group（5 times / h≤AHI≤15 times / h，n=6），moderate group（15 times/h<AHI≤30 times / h，n=11）and severe group（AHI>30 times / h，n=41）.PSG was conducted at the night of admission day and on the next early morning，peripheral arterial blood was drawn.The concentration of leptin，orexin，and Ghrelin were tested by ELISA.General clinical data were collected，including sex，age，BMI，history of smoking，drinking，hypertension，diabetes，and chronic rhinitis，neck，waist and hip circumferences，pre-sleep and morning systolic and diastolic blood pressures，total time in bed，total sleep time，AHI，total number of microarousals，number of microarousals lasting for longer than 15 seconds，microarousal index，the percent of the total time with oxygen saturation level lower than 90%（T90%），the lowest oxygen saturation，arterial partial pressure of oxygen（PaO2），arterial partial pressure of carbon dioxide（PaCO2），fasting blood glucose，total cholesterol，triacylglycerol，high-density lipoprotein，low-density lipoprotein，leptin，Ghrelin，and orexin levels.Ordinal Logistic regression analysis was used to explore the influencing factors of OSAHS severity .Spearman's rank correlation or Pearson correlation analysis was used to explore the associations of metabolic and clinical related parameters.Results　 The mild，moderate and severe groups showed statistically significant differences in AHI，microarousal index，T90% and the lowest oxygen saturation（P<0.05）.Ordinal logistic regression analysis showed that T90%〔OR=1.138，95%CI（1.026，1.262）〕was an independent factor associated with the severity of OSAHS（P<0.05）.Leptin level was positively correlated with BMI（r=0.482），waist circumference（r=0.429），hip circumference（r=0.576），and pre-sleep systolic blood pressure（r=0.261），but was negatively correlated with PaO2（P<0.05）.Ghrelin level was negatively correlated with smoking history（rs=-0.273），drinking history（rs=-0.309），pre-sleep systolic blood pressure（r=-0.391）and diastolic blood pressure（r=-0.282）（P<0.05）.Orexin was negatively correlated with total time in bed（r=-0.320，P<0.05）.Conclusion　T90% is a simple indicator that could effectively identity people at high risk of OSAHS，which is of some guiding significance to the evaluation of OSAHS severity.The interaction of factors such as hypoxia and obesity can promote the increase of leptin concentration in OSAHS patients，and induce the onset of leptin resistance，resulting in metabolic disorders.Orexin may play a role in maintaining wakefulness.Ghrelin plays a certain role in the physiological process of regulating blood pressure，which may provide a new idea or direction for the prevention，diagnosis and treatment of OSAHS patients cardiovascular diseases.Sleep fragmentation shortens the duration of sleep，and promotes the increase of orexin levels in the body，leading to higher risk of developing obesity.

Key words: Sleep apnea, obstructive；Leptin；Orexin；Ghrelin；PSG

摘要： 背景　阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种临床常见的睡眠障碍，而肥胖是引起OSAHS的主要危险因素，代谢相关激素的水平及肥胖的发生可能引发OSAHS患者的睡眠相关事件，其原因尚未明确，且目前同时探索瘦素、食欲素及生长激素释放肽与OSAHS患者睡眠监测指标关系的研究较少。目的　探讨OSAHS病程严重程度的影响因素，分析OSAHS患者瘦素、食欲素及生长激素释放肽与代谢指标和睡眠监测指标的相关性。方法　选择2017年12月—2018年12月在中国医科大学附属盛京医院睡眠医学中心经多导睡眠监测（PSG）诊断为OSAHS且自愿加入本研究的58例患者为研究对象，根据睡眠呼吸暂停低通气指数（AHI）分为轻度组（5次/h≤AHI≤15次/h，n=6）、中度组（15次/h<AHI≤30次/h，n=11）、重度组（AHI>30次/h，n=41）。研究对象入院当晚进行PSG，次日清晨抽取外周动脉血，使用酶联免疫吸附法（ELISA）测定瘦素、食欲素和生长激素释放肽水平，记录患者的一般临床情况：性别、年龄、体质指数（BMI）、吸烟史、饮酒史、高血压、糖尿病、慢性鼻炎、颈围、腰围、臀围、睡前收缩压、睡前舒张压、晨起收缩压、晨起舒张压、总卧床时间（TIB）、总睡眠时间（TST）、AHI、总共微觉醒次数、>15 s微觉醒次数、微觉醒指数、血氧低于90%时间（T90%）、最低氧饱和度、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、瘦素、生长激素释放肽、食欲素水平等。采用有序Logistic回归分析探讨OSAHS病情严重程度的影响因素，采用Spearman秩相关或Pearson相关性分析探讨代谢相关激素与临床相关指标的关系。结果　3组间AHI、微觉醒指数、T90%、最低氧饱和度比较，差异均有统计学意义（P<0.05）。有序Logistic回归分析结果显示，T90%〔OR=1.138，95%CI（1.026，1.262）〕是OSAHS严重程度的独立影响因素（P<0.05）。瘦素水平与BMI（r=0.482）、腰围（r=0.429）、臀围（r=0.576）、睡前收缩压（r=0.261）呈正相关（P<0.05），与PaO2（r=-0.301）呈负相关（P<0.05）；生长激素释放肽水平与吸烟史（rs=-0.273）、饮酒史（rs=-0.309）、睡前收缩压（r=-0.391）和睡前舒张压（r=-0.282）呈负相关（P<0.05）；食欲素与TIB呈负相关（r=-0.320，P<0.05）。结论　T90%对OSAHS患者病情严重程度评估具有一定指导意义，提示其能较为简单有效的识别高危人群。缺氧及肥胖等因素相互作用，可能促使OSAHS患者体内瘦素水平上升，进而产生瘦素抵抗，最终造成机体代谢紊乱的发生。生长激素释放肽在调节血压的生理过程中起到一定作用，为OSAHS患者是否并发心血管疾病的诊治和预防提供了新思路、新方向。食欲素可能起到维持觉醒的作用，睡眠片段化使睡眠持续时间缩短，促使体内食欲素水平上升，促进肥胖的发生发展。

关键词: 睡眠呼吸暂停, 阻塞性；瘦素；食欲素；生长激素释放肽；多导睡眠监测