阻塞性睡眠呼吸暂停/低通气综合征合并红细胞增多症的对照研究

A case-control study of erythrocytosis in obstructive sleep apnoea/hypoventilation syndrome

目的 探讨阻塞性睡眠呼吸暂停 /低通气综合征 (OSAHS)合并红细胞增多症的临床特点及危险因素。方法 收集 1 995年 1月至 2 0 0 2年 1 2月门诊及住院的OSAHS患者的资料 ,红细胞增多症病例组与无红细胞增多症对照组按年龄、性别、体质指数及就诊时间行 1∶3匹配。分析其临床特点 ,用Logistic回归法评估发生红细胞增多的危险因素。结果 OSAHS并红细胞增多症 4 2例 ,呼吸暂停低通气指数 (AHI) >4 0 /h。红细胞容量测定符合绝对性红细胞增多症 4例、相对性红细胞增多症 38例。经鼻持续正压治疗 (nCPAP)后 ,红细胞增多症恢复的中位时间为 6d。多因素分析 ,高血压、男性、冠心病及脑卒中时发生红细胞增多症的比数比 (OR值 )分别为 1 0 .7、1 .7、1 .3及 9.1。结论 OSAHS患者引起继发性红细胞增多症仅见于少数病例 ,大多为相对性红细胞增多症 ,推测与睡眠中窒息、应激及体液减少有关。治疗OSAHS后常很快缓解。高血压、AHI >4 0、男性是发生红细胞增多症的主要因素。冠心病。

Objective To investigate the clinical characteristics and predictors of erythrocytosis in obstructive sleep apnea/hypoventilation syndrome (OSAHS).Methods OSAHS patients with and without erythrocytosis were 1∶3 matched in age, sex, the apnea/ventilation index (AHI),weigh index and diagnostic time.The results were compared clinically and analyzed retrospectively by multiple Logistic analysis.Results Erythrocytosis were only found in severe patients with AHI>40/h.Only 4 secondary plycythemia were confirmed by increasing volume of red cell mass.Thirty eight patients were diagnosed as relative erythrocytosis (as Gaisbck syndrome).The medianremission time of erythrocytosis was 6 days when therapeutic nasal continuous positive airway pressure(nCPAP) were given to OSAHS patients(Kaplan Meier survival analysis,95% confidence: 6.12 ～9.12).Odds Ratio for hypertension,male,gender coronary heart disease and stroke was 10.7,1.7,1.3, 9.1 respectively.Conclusions Secondary polycythemia is an infrequent disorder but the relative erythrocytosis (Gaisbck syndrome) is more common in patients with OSAHS,which can be improved easily after nCPAP treatment.Hypertension,male gender and AHI>40 are independent risk factors for erythrocytosis.The OR increased in coronary heart disease and stroke may be the result of erythrocytosis.