老年人心血管疾病与阻塞性睡眠呼吸暂停综合征的关系

Association between obstructive sleep apnea-hypopnea syndrome with cardiovascular diseases in the aged

目的探讨老年心血管疾病与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的关系。方法采用RS-611床垫式睡眠呼吸监测系统监测31例老年心血管病患者睡眠呼吸状况,分析其与心血管病的关系。结果(1)29例检出睡眠呼吸暂停和(或)低通气事件,26例诊断OSAHS,27例低氧血症。(2)患者年龄与低通气指数(HI)及患有冠心病、高血压、脑梗死、糖尿病等疾病数显著正相关(分别为r=0.392,P<0.05;r=0.710,P=0.01);≥80岁组患退行性心瓣膜病、糖尿病、肾衰病例数显著高于<80岁组(2χ值分别=11.519,9.120,4.377,P<0.01,0.01,0.05),HI明显高于<80岁组(9.8±10.6对比2.6±1.7,P<0.05),夜间最低血氧饱和度(LO2)、平均血氧饱和度(AO2)明显低于<80岁组[(76.4±8.3)%对比(81.9±5.9)%,(82.6±2.2)%对比(94.0±1.2)%,P<0.05]。(3)冠脉严重病变组呼吸暂停指数(AI)和呼吸紊乱指数(AHI)明显高于对照组(16.5±9.6对比9.3±6.4,23.4±14.6对比14.3±9.3,均P<0.05);瓣膜返流组LO2明显低于对照组[(75.6±8.0)%对比(81.8±6.2)%,P<0.05)]。AHI≥15组冠脉严重病变、高尿酸血症病例数显著多于AHI<15组(2χ值分别为5.154,5.148,均P<0.05)。结论老年患者多同时患有多种心血管疾病和OSAHS,患病病种及低通气程度均随增龄增加,OSAHS的严重程度与冠脉严重病变、高尿酸血症以及老年心肾功能的减退相一致。

Objective To investigate the association between obstructive sleep apnea-hypopnea syndrome （OSAHS） with cardiovascular diseases （CVD） in the aged. Methods 31 patients whose ages average 76.4 ±7.2 with CVD were monitored by RS-611 mattress monitoring system of sleep. The data of sleep-disordered breathing and the relationship between OSAHS and CVD were analyzed. Results The events of sleep apnea and/or hypopnea were detected in 29 cases,26 of them were diagnosed as OSAHS according to AHI and 27 cases were as hypoxemia. Hypopnea index（HI） and the number of CVD were positively correlated with the ages of patients （ r = 0. 392, P 〈 0.05 and r = 0.710,P = 0. 000, respectively）. Left ventricular ejection fraction was nagetively correlated with the ages of patients（r = -0. 356,P =0. 053 ）. The cases with retrograde valvular disease, diabetes or renal failure in the age≥ 80 group were significantly more than that in control group （ 10/14 vs 2/17, P 〈 0.01,10/14 vs 3/17, P 〈 0.01 and 5/14 vs 1/17, P 〈 0.05, respectively）. Apnea index （AI） and apnea-hypopnea index （AHI） in the patients with AMI and （or） coronary artery stenosis found by angiography were markedly higher than that in control （ 16.5 ± 9.6 vs 9.3 ±6.4,23.4 ±14.6 vs14.3 ±9.3 ,P 〈0.05 ,respectively）. The lowest saturation of blood oxygen （LO2 ） in the patients with senile retrograde valvular disease was remarkably lower （75.6% ±8.0% vs 81.8% ±6. 2%, P 〈 0.05 ）than that in control. The cases of serious CVD or hyperuricemia in AHI ≥ 15 group were more than that in AHI 〈 15 group （7/12 vs 3/17,6/12 vs 2/17 ,P 〈0.05 ,respectively）. Conclusions The CVD and OSAHS frequently simultaneously occur in the aged and become serious with age increasing. Severity degree of OSAHS is consistent with that of CVD, hyperuricemia and heart failure.