收稿日期: 2021-12-13
录用日期: 2022-04-18
网络出版日期: 2022-04-28
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
Received date: 2021-12-13
Accepted date: 2022-04-18
Online published: 2022-04-28
Supported by
Project of Shanghai Municipal Commission of Health and Family Planning(20184Y0100)
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
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 . DOI: 10.3969/j.issn.1674-8115.2022.04.011
·To explore the effect of apnea hypopnea index (AHI) on arterial stiffness in patients of obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with hypertension.
·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.
·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.
·Elevated AHI increases the risk of arterial stiffness in the patients of OSAHS complicated with hypertension.
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