阻塞性睡眠呼吸暂停低通气综合征与冠心病关系的临床研究

The relationship between obstructive sleep apnea-hypopnea syndrome and coronary heart diasease

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与冠心病的关系,为预防冠心病的提供理论依据。方法回顾性分析126例打鼾患者(曾经冠状动脉造影)进行6睡眠呼吸监测,根据睡眠监测得出的睡眠呼吸暂停低通气指数(AH)I分为轻度OSAHS组(5次/h≤AHI≤20次/h39例)、中重度OSAHS组(AHI>20次/h61例)和对照组(AHI<5次/h26例);观察各组年龄、性别、体质指数(BM)I、血清胆固醇、甘油三脂、血糖、尿酸、高敏C反应蛋白(hsCRP)及睡眠各项指标变化,比较3组间各观察指标的差异;对OSAHS组和对照组合并冠心病、高血压、及高脂血症的情况进行比较;对OSAHS组hsCRP、尿酸与AHI、最低脉搏容积血氧饱和度(LSpO)2和氧减<90%的时间T90(min)的相关性进行分析。结果3组间年龄及性别相比差异均无统计学意义(P均>0.05)。OSAHS组合并冠心病、高血压、高脂血症的百分率与对照组比较差异有统计学意义,合并糖尿病的百分率与对照组比较差异无统计学意义。轻度OSAHS组中43.6%患有冠心病,中重度OSAHS组中47.5%患有冠心病。轻度OSAHS组和重度OSAHS组血清hsCRP和尿酸水平分别为(3.1mg/L,3.7mg/L),(389±79.12)μmol/L,(403±92.47)μmol/L显著高于对照组1.7mg/L,(305.51±58.37)μmol/L;OSAHS组血清hsCRP水平和血清尿酸水平与AHI,T90(min)呈正相关,与LSpO2呈负相关。结论OSAHS患者hsCRP及尿酸与AHI,T90(min)及LSpO2有较强的相关性,提示OSAHS患者反复发作低氧血症和炎性反应可能是冠心病高发的原因。

Objective To study the relationship between obstructive sleep apnea-hypopnea syndrome （OSAHS） and the occurrence and development of coronary heart disease. Methods From March of 2004 to May of 2009, 126 subjects admitted into Department of Respiratory of the Second of Yunnan People＇s Hospital were recruited. They were divided into three groups based on their nocturnal apnea hypopnea index （AHI）detected by examination of polysomnography ： mild OSAHS group （5/h ≤ AHI ≤ 20/h ,39 cases）, moderate-to-severe group （AHI 〉 20/h, 61 cases） ,and 26 snorers without OSAHS were selected as control group （AHI〈 5/h）. Coronary artery angiography were performed in all three groups. The differences of age, sex, BMI, plasma cholesterol, triglyceride, glucose, uric acid, high sensitivity C-reactive protein （hsCRP）, AHI, LSpO2 and T90 among three groups were analyzed. The differences of complicated coronary heart disease, hypertension and hyperlipoidemia between OSAHS and control group were studied, the correlation between hsCRP ,uric acid and AHI,LSpO2 and T90 were analyzed. Results Compared with the control group, the AHI was significantly higher in OSAHS groups（mild 11.26 ± 4.03, severe 49.68± 16.87versus3. 12± 1.52）. The lowest SpO2 was significantly lower in OSAHS groups（85%, 76%） than that in the control group（90%）. The total recorded time spent below 90% oxygen saturation （T90%）（min） （1.9, 37.9） was significantly higher in OS- AHS groups than that in the control group（0.0）. Compared with the control group, the age and sex did not show significant difference（P〉0.05）. The incidence of coronary heart disease was significantly higher in OSAHS groups （mild 43.6% and moderate-to severe 47.5%） than in the control group（11.5%）. The plasma hsCRP and uric levels were significantly higher in patients with OSAHS groups than that in the control group（P〈0.01）. HsCRP and serum uric acid were positively correlative with AHI and T90（min）,but negatively with the lowest SpO2. Conclusion There is a high prevalence of coronary heart disease in patients with OSAHS. The occurrence of coronary heart disease in OSAHS patients is probably related to recurrent nocturnal hypoxemia and inflammation during sleep