阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的呼吸紊乱指数与动脉硬化的相关性研究

doi:10.3969/j.issn.1674-8115.2022.04.011

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (4): 490-495.doi: 10.3969/j.issn.1674-8115.2022.04.011

阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的呼吸紊乱指数与动脉硬化的相关性研究

唐碧雯(), 白娅娅, 胡月亮, 晁慧娟, 王潜, 左君丽()

上海交通大学医学院附属瑞金医院老年病科，上海 201801

收稿日期:2021-12-13 接受日期:2022-04-18 出版日期:2022-04-28 发布日期:2022-04-28
通讯作者: 左君丽 E-mail:tbw12673@rjh.com.cn;zjl12616@rjh.com.cn
作者简介:唐碧雯（1986—），女，主治医师，硕士；电子信箱：tbw12673@rjh.com.cn。
基金资助:
上海市卫生和计划生育委员会青年项目(20184Y0100)

Correlation between apnea hypopnea index and arteriosclerosis in patients with obstructive sleep apnea hypopnea syndrome complicated with hypertension

TANG Biwen(), BAI Yaya, HU Yueliang, CHAO Huijuan, WANG Qian, ZUO Junli()

Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China

Received:2021-12-13 Accepted:2022-04-18 Online:2022-04-28 Published:2022-04-28
Contact: ZUO Junli E-mail:tbw12673@rjh.com.cn;zjl12616@rjh.com.cn
Supported by:
Project of Shanghai Municipal Commission of Health and Family Planning(20184Y0100)

摘要/Abstract

摘要：

目的·探究呼吸紊乱指数（apnea hyponea index，AHI）对阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）合并高血压患者动脉硬化的影响。方法·选择2018年7月—2020年12月于上海交通大学医学院附属瑞金医院老年病科住院且行多导睡眠监测的OSAHS患者，收集患者临床及实验室指标，同时行24 h动态血压监测及颈动脉-股动脉脉搏波传导速度（carotid-femoral pulse wave velocity，c-fPWV）测定。将患者根据AHI进行分组，5次/h<AHI<15次/h为轻中度OSAHS组，AHI≥15次/h为中重度OSAHS组。采用Logistic回归分析AHI与动脉硬化及心血管疾病危险因素包括年龄、体质量指数（body mass index，BMI）、夜间收缩压、夜间舒张压、低密度脂蛋白、空腹血糖、估算肾小球滤过率、是否使用他汀类及降糖药物的相关性。结果·共纳入365例患者，平均年龄（49.1±12.8）岁，326例（89.3%）为男性，BMI为（28.1±3.8）kg/m²。中重度OSAHS组患者257例，轻中度OSAHS组患者108例。中重度OSAHS组BMI、c-fPWV、空腹血糖和糖化血红蛋白（ HbA1c）水平均显著高于轻中度OSAHS组（均P<0.05）；AHI与c-fPWV呈显著正相关（R²=0.047，P=0.001）。在291例OSAHS合并高血压患者中，中重度OSAHS患者（216例）c-fPWV、空腹血糖和HbA1c水平显著高于轻中度OSAHS患者（75例），差异有统计学意义（均P<0.05）。经校正年龄、BMI、AHI、夜间收缩压、夜间舒张压、低密度脂蛋白、空腹血糖、估算肾小球滤过率、是否服用他汀类及降糖药物，Logistic回归结果显示，AHI（OR=1.032，95% CI 1.009~1.055，P=0.006）、年龄（OR=1.078，95% CI 1.021~1.138，P=0.007）、夜间收缩压（OR=1.058，95% CI 1.010~1.109，P=0.017）为c-fPWV升高的独立危险因素。结论·OSAHS合并高血压患者AHI升高，发生动脉硬化的风险增加。

关键词: 睡眠呼吸暂停低通气综合征, 脉搏波传导速度, 呼吸紊乱指数, 动脉硬化

Abstract:

Objective·To explore the effect of apnea hypopnea index (AHI) on arterial stiffness in patients of obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with hypertension.

Methods·The patients admitted to Ruijin Hospital,Shanghai Jiao Tong University School of Medicine, from July 2018 to December 2020 for polysomnography monitoring were enrolled, and divided into mild to moderate OSAHS group and moderate to severe OSAHS group according to AHI (5 times/h < AHI < 15 times/h or AHI≥15 times/h). Clinical and biochemical parameters were collected. 24-hour ambulate blood pressure and carotid-femoral pulse wave velocity (c-fPWV) were measured. Logistic regression analysis was performed between AHI and cardiovascular risk factors including age, body mass index (BMI), nocturnal systolic blood pressure, nocturnal diastolic blood pressure, low-density lipoprotein, fasting blood glucose, estimated glomerular filtration rate (eGFR), using of statin and hypoglycemic drugs.

Results·A total of 365 patients were enrolled with an average age of (49.1±12.8) years. Three hundred and twenty-six (89.3%) were male and average BMI was (28.1±3.8) kg/m². BMI, c-fPWV, fasting blood glucose and glycosylated hemoglobin (HbA1c) in moderate to severe OSAHS group (n=257) were significantly higher than those in mild to moderate OSAHS group (n=108)(P<0.05), and there was a significant positive correlation between AHI and c-fPWV (R²=0.047, P<0.001). In patients of OSAHS complicated with hypertension (n=291), c-fPWV, fasting blood glucose and HbA1c in moderate to severe OSAHS group (n=216) were significantly higher than those in mild to moderate OSAHS group (n=75) (P<0.05). After adjusting for age, BMI, AHI, nocturnal systolic blood pressure, nocturnal diastolic blood pressure, low density lipoprotein, fasting blood glucose, eGFR, medication of statin and hypoglycemic drugs, the Logistic regression model showed that AHI (OR=1.032, 95% CI 1.009?1.055, P=0.006), age (OR=1.078, 95%CI 1.021?1.138, P=0.007), and nocturnal systolic blood pressure (OR=1.058, 95% CI 1.010?1.109, P=0.017) were independent risk factors for c-fPWV elevation.

Conclusion·Elevated AHI increases the risk of arterial stiffness in the patients of OSAHS complicated with hypertension.

Key words: obstructive sleep apnea hypopnea syndrome (OSAHS), pulse wave velocity, apnea hypopnea index (AHI), arterial stiffness

中图分类号:

R563.9

唐碧雯, 白娅娅, 胡月亮, 晁慧娟, 王潜, 左君丽. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的呼吸紊乱指数与动脉硬化的相关性研究[J]. 上海交通大学学报（医学版）, 2022, 42(4): 490-495.

TANG Biwen, BAI Yaya, HU Yueliang, CHAO Huijuan, WANG Qian, ZUO Junli. Correlation between apnea hypopnea index and arteriosclerosis in patients with obstructive sleep apnea hypopnea syndrome complicated with hypertension[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(4): 490-495.

图/表 5

参考文献 19

1	OLIVER J J, WEBB D J. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events[J]. Arterioscler Thromb Vasc Biol, 2003, 23(4): 554-566.
2	FLORAS J S. Sleep apnea and cardiovascular disease: an enigmatic risk factor[J]. Circ Res, 2018, 122(12): 1741-1764.
3	MURPHY A M, THOMAS A, CRINION S J, et al. Intermittent hypoxia in obstructive sleep apnoea mediates insulin resistance through adipose tissue inflammation[J]. Eur Respir J, 2017, 49(4): 1601731.
4	WILLIAMS B, MANCIA G, SPIERING W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension[J]. J Hypertens, 2018, 36(10): 1953-2041.
5	ZHAO X, YU X F, XIN S X, et al. Correlation between OSAHS and early peripheral atherosclerosis indices in patients with type 2 diabetes mellitus in China: a cross-sectional inpatient study[J]. J Diabetes Res, 2021, 2021: 6630020.
6	VLACHOPOULOS C, AZNAOURIDIS K, TERENTES-PRINTZIOS D, et al. Prediction of cardiovascular events and all-cause mortality with brachial-ankle elasticity index: a systematic review and meta-analysis[J]. Hypertension, 2012, 60(2): 556-562.
7	BLACHER J, SAFAR M E. Large-artery stiffness, hypertension and cardiovascular risk in older patients[J]. Nat Clin Pract Cardiovasc Med, 2005, 2(9): 450-455.
8	BERRY R B, BUDHIRAJA R, GOTTLIEB D J, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine[J]. J Clin Sleep Med, 2012, 8(5): 597-619.
9	KARIO K, PARK S, CHIA Y C, et al. 2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network[J]. J Clin Hypertens (Greenwich), 2020, 22(3): 351-362.
10	DRAGER L F, POLOTSKY V Y, O'DONNELL C P, et al. Translational approaches to understanding metabolic dysfunction and cardiovascular consequences of obstructive sleep apnea[J]. Am J Physiol Heart Circ Physiol, 2015, 309(7): H1101-H1111.
11	VLACHOPOULOS C, AZNAOURIDIS K, STEFANADIS C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis[J]. J Am Coll Cardiol, 2010, 55(13): 1318-1327.
12	PHILLIPS C L, BUTLIN M, WONG K K, et al. Is obstructive sleep apnoea causally related to arterial stiffness? A critical review of the experimental evidence[J]. Sleep Med Rev, 2013, 17(1): 7-18.
13	BORSINI E, BLANCO M, BOSIO M, et al. Prevalence of sleep apnea and cardiovascular risk factors in patients with hypertension in a day hospital model[J]. Clin Exp Hypertens, 2018, 40(3): 231-237.
14	STEIN J H, STERN R, BARNET J H, et al. Relationships between sleep apnea, cardiovascular disease risk factors, and aortic pulse wave velocity over 18 years: the Wisconsin Sleep Cohort[J]. Schlaf Atmung, 2016, 20(2): 813-817.
15	VOLGMAN A S, PALANIAPPAN L S, AGGARWAL N T, et al. Atherosclerotic cardiovascular disease in south asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American heart association[J]. Circulation, 2018, 138(1): e1-e34.
16	DEOL R, LEE K A, KANAYA A M, et al. Obstructive sleep apnea risk and subclinical atherosclerosis in South Asians living in the United States[J]. Sleep Health, 2020, 6(1): 124-130.
17	TAN X, BENEDICT C. Sleep characteristics and HbA1c in patients with type 2 diabetes on glucose-lowering medication[J]. BMJ Open Diabetes Res Care, 2020, 8(1): e001702.
18	CIGNARELLI A, CIAVARELLA A, BARBARO M, et al. Postprandial glucose and HbA1c are associated with severity of obstructive sleep apnoea in non-diabetic obese subjects[J]. J Endocrinol Invest, 2021, 44(12): 2741-2748.
19	GRIMALDI D, BECCUTI G, TOUMA C, et al. Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications[J]. Diabetes Care, 2014, 37(2): 355-363.

Indicator	Value （n=365）
Age/year	49.1±12.8
BMI/（kg‧m^-2）	28.1±3.8
Waist-hip ratio	1.0±0.1
Gender/n（%）
Male	326 （89.3）
Female	39 （10.7）
Group/n（%）
Mild to moderate OSAHS	108 （29.6）
Moderate to severe OSAHS	257 （70.4）
Smoking/n（%）	122 （33.4）
Drinking/n（%）	94 （25.8）
Diabetes/n（%）	75 （20.5）
Hypertension/n（%）	291 （79.7）

Indicator	Value （n=365）
Age/year	49.1±12.8
BMI/（kg‧m^-2）	28.1±3.8
Waist-hip ratio	1.0±0.1
Gender/n（%）
Male	326 （89.3）
Female	39 （10.7）
Group/n（%）
Mild to moderate OSAHS	108 （29.6）
Moderate to severe OSAHS	257 （70.4）
Smoking/n（%）	122 （33.4）
Drinking/n（%）	94 （25.8）
Diabetes/n（%）	75 （20.5）
Hypertension/n（%）	291 （79.7）

Indicator	Mild to moderate OSAHS group （n=108）	Moderate to severe OSAHS group （n=257）	P value
Age/year	44.6±11.8	50.9±12.8	0.000
BMI/（kg‧m^-2）	27.5±3.2	28.3±4.0	0.045
Heart rate/（beats‧min^-1）	82±12	77±14	0.001
Waist-hip ratio	0.99±0.08	0.98±0.06	0.398
c-fPWV/（m‧s^-1）	7.62±1.48	10.03±3.67	0.000
LDL-C/（mmol‧L^-1）	3.10±1.09	3.33±2.03	0.320
FPG/（mmol‧L^-1）	5.43±0.77	6.09±2.25	0.000
HbA1c/%	5.80±0.73	6.16±1.21	0.006
eGFR /［mL‧（min‧1.73m²）^-1］	95.9±16.1	91.8±16.5	0.044

Indicator	Mild to moderate OSAHS group （n=108）	Moderate to severe OSAHS group （n=257）	P value
Age/year	44.6±11.8	50.9±12.8	0.000
BMI/（kg‧m^-2）	27.5±3.2	28.3±4.0	0.045
Heart rate/（beats‧min^-1）	82±12	77±14	0.001
Waist-hip ratio	0.99±0.08	0.98±0.06	0.398
c-fPWV/（m‧s^-1）	7.62±1.48	10.03±3.67	0.000
LDL-C/（mmol‧L^-1）	3.10±1.09	3.33±2.03	0.320
FPG/（mmol‧L^-1）	5.43±0.77	6.09±2.25	0.000
HbA1c/%	5.80±0.73	6.16±1.21	0.006
eGFR /［mL‧（min‧1.73m²）^-1］	95.9±16.1	91.8±16.5	0.044

Indicator	OSAHS without hypertension （n=74）			OSAHS with hypertension （n=291）
Indicator	Mild to moderate OSAHS	Moderate to severe OSAHS	P value	Mild to moderate OSAHS	Moderate to severe OSAHS	P value
BMI/（kg‧m^-2）	26.9±4.3	27.6±4.5	0.525	27.8±2.6	28.5±3.9	0.092
Waist-hip ratio	1.0±0.1	1.0±0.1	0.991	1.0±0.1	1.0±0.1	0.860
c-fPWV/（m‧s^-1）	7.5±2.5	9.8±3.8	0.123	7.6±1.2	10.1±3.3	0.000
Day SBP/mmHg	135±19	127±12	0.166	135±14	135±15	0.918
Day DBP/mmHg	90±13	82±9	0.052	91±10	89±11	0.104
Night SBP/mmHg	123±18	118±14	0.370	128±16	128±17	0.996
Night DBP/mmHg	78±13	74.0±7.8	0.395	84±11	82±12	0.189
24 h SBP/mmHg	132±18	125±12	0.117	132±14	133±14	0.725
24 h DBP/mmHg	87±13	80±8	0.052	89±10	87±11	0.148
Uric acid/（μmol‧L^-1）	394.5±68.8	400.8±112.1	0.797	428.4±87.0	412.6±88.9	0.186
LDL-C/（mmol‧L^-1）	3.4±1.6	3.1±0.9	0.381	3.0±0.9	3.4±2.1	0.180
FPG/（mmol‧L^-1）	5.5±0.8	5.6±1.3	0.815	5.4±0.8	6.2±2.3	0.000
HbA1c/ %	5.7±0.6	5.9±1.0	0.524	5.8±0.8	6.2±1.2	0.014
eGFR/［mL‧（min‧1.73m²）^-1］	93.8±18.3	97.2±11.0	0.443	96.6±15.4	91.0±17.0	0.017
Carotid-IMT/mm	0.7±0.2	0.7±0.2	0.744	0.7±0.1	0.7±0.2	0.903

阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的呼吸紊乱指数与动脉硬化的相关性研究

Correlation between apnea hypopnea index and arteriosclerosis in patients with obstructive sleep apnea hypopnea syndrome complicated with hypertension

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 19

相关文章 15

编辑推荐

Metrics

Indicator	B	S.E.	Sig.	Exp （B）	95% CI for EXP （B）
Indicator	B	S.E.	Sig.	Exp （B）	Lower	Upper
Constant	-5.855	3.967	0.140	0.003
Age	0.075	0.028	0.007	1.078	1.021	1.138
BMI	-0.112	0.075	0.138	0.894	0.772	1.036
AHI	0.031	0.011	0.006	1.032	1.009	1.055
Night-SBP	0.057	0.024	0.017	1.058	1.010	1.109
Night-DBP	-0.049	0.031	0.112	0.952	0.897	1.011
LDL-C	-0.283	0.228	0.215	0.754	0.482	1.178
FPG	0.263	0.220	0.231	1.301	0.846	2.000
eGFR	-0.014	0.017	0.412	0.986	0.954	1.019
Statins	0.475	0.488	0.330	1.608	0.618	4.181
Hypoglycemic drugs	0.727	0.552	0.188	2.068	0.702	6.097

[1]	董姣姣1，唐兰2，孙艳丽2，姚晓倩1，王婧1，王永红2，彭斌1. 基于倾向性评分匹配法探索血糖与动脉硬化的关系[J]. 上海交通大学学报（医学版）, 2020, 40(4): 494-.
[2]	陈淑梅，吴佳欐，李晓艳. 阻塞性睡眠呼吸暂停低通气综合征患儿血压与儿茶酚胺水平的关系研究[J]. 上海交通大学学报（医学版）, 2019, 39(12): 1437-.
[3]	徐梦丹，戴秋艳. 血压变异性与脉搏波传导速度及左心室质量指数的相关性[J]. 上海交通大学学报（医学版）, 2018, 38(2): 184-.
[4]	王洁 1，杨克 2，陈敬贤 1，吕玲玲 1，卞晓岚 3，郑岚 1. 徐黄合剂对糖尿病性下肢动脉硬化闭塞症的疗效观察[J]. 上海交通大学学报（医学版）, 2018, 38(11): 1333-.
[5]	应晨 1，刘彩虹 2，胡家安 2，江石湖 3，徐志红 2，孙璟 2. 阻塞性睡眠呼吸暂停低通气综合征合并非酒精性脂肪性肝病患者血清脂肪代谢相关激素水平的研究[J]. 上海交通大学学报（医学版）, 2018, 38(10): 1203-.
[6]	谢锐，冯洋洋，温跃桃，任为. RCAN1及CnA在下肢闭塞性动脉硬化支架术后再狭窄组织中的表达及意义[J]. 上海交通大学学报（医学版）, 2017, 37(3): 298-.
[7]	孙雯雯，阮玉凤，连鹏，应晨，胡家安，徐志红，孙璟. 阻塞性睡眠呼吸暂停低通气综合征对非酒精性脂肪性肝病的影响[J]. 上海交通大学学报（医学版）, 2016, 36(5): 707-.
[8]	张豫文，石娟，张翼飞，顾卫琼，王卫庆，洪洁. 青少年肥胖人群发生阻塞性睡眠呼吸暂停低通气综合征的代谢相关高危因素[J]. 上海交通大学学报（医学版）, 2016, 36(12): 1726-.
[9]	唐志君，韦宗辉，吴勇德，文飞，田川. 重度阻塞性睡眠呼吸暂停低通气综合征患者的肺功能分析[J]. 上海交通大学学报（医学版）, 2016, 36(12): 1817-.
[10]	戴茜茜，汪海娅. 假性高血压的研究进展[J]. 上海交通大学学报（医学版）, 2015, 35(3): 450-.
[11]	左君丽，常桂丽，葛茜，等. 原发性高血压伴慢性肾脏病与动脉硬化的关系[J]. 上海交通大学学报（医学版）, 2015, 35(11): 1619-.
[12]	王彦, 李庆云, 林莹妮, 等. 成年男性睡眠呼吸暂停综合征患者血清内脏脂肪素的变化[J]. , 2012, 32(4): 503-.
[13]	李发红, 魏方菲, 邹军, 等. 血浆抵抗素、高敏C反应蛋白与动脉硬化的关系[J]. , 2012, 32(3): 296-.
[14]	葛丽娜, 方炜, 张琳, 等. 腹膜透析患者脉压的影响因素及其与患者病死率的关系[J]. , 2012, 32(3): 307-.
[15]	马冠华, 李敏, 陈聆, 等. 女性阻塞性睡眠呼吸暂停低通气综合征与代谢综合征相关研究[J]. , 2010, 30(2): 218-.