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

Study of obstructive sleep apnea-hypopnea syndrome and metabolic syndrome in females

目的研究和分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)女性患者代谢指标变化以及合并代谢综合征(MS)的情况,探讨MS与OSAHS的关系。方法2006年8月—2009年5月,瑞金医院睡眠呼吸疾病诊疗中心纳入女性研究对象60例,分为单纯鼾症组(n=19)、轻度OSAHS组(n=21)和中重度OSAHS组(n=20),比较各组间Epworth嗜睡量表(ESS)评分及代谢相关指标的差异。其中41例OSAHS患者再分为合并MS组(n=15)与无MS组(n=26),比较两组间ESS评分、呼吸暂停低通气指数(AHI)、氧减指数(ODI)和最低血氧饱和度(LSpO_2)的差异。结果在单纯鼾症、轻度OSAHS与中重度OSAHS组,组间年龄和体质量指数(BMI)以及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白A-Ⅰ(apoA-Ⅰ)和载脂蛋白B(apoB)比较差异均无统计学意义(P>0.05);相关分析示ESS与AHI呈正相关(r=0.327,P=0.011);中重度OSAHS组ESS评分、高血压比例、空腹血糖(FPG)以及合并MS比例均明显高于单纯鼾症组(P<0.05)。与无MS组比较,合并MS组BMI、FPG、TG、高血压比例以及ODI和ESS评分均较高(P<0.05);两组间AHI、LspO_2差异无统计学意义(P>0.05)。结论ESS评分可反映女性OSAHS病情的严重程度。年龄、BMI相匹配的女性OSAHS患者血脂指标无差异,但随着病情加重可引起糖代谢异常,高血压发病增加,合并MS的比例升高;合并MS的OSAHS患者病情更严重,MS与OSAHS两者互为影响。

Objective To analyse the changes of metabolic parameters and condition of metabolic syndrome （MS） in females with obstructive sleep apnea-hypopnea syndrome （OSAHS）, and explore the interaction between OSAHS and MS. Methods Sixty females undergoing polysomnography were included, and were divided into simple snorer group （ n = 19）, mild OSAHS group （n = 21） and moderate to severe OSAHS group （n = 20）. Epworth sleepiness scale （ESS） scores and metabolic parameters were compared among groups. Forty-one patients with OSAHS were subdivided into group with MS （ MS group, n= 15） and group without MS （non-MS group, n = 26）. ESS scores, apnea hypopnea index （AHI）, oxygen desaturation index （ODI） and lowest pulse oxygen saturation （LSpO2） were compared between MS group and non-MS group. Results There was no significant difference in age, body mass index （BMI）, total cholesterol （TC）, triglyceride （TG）, low density cholesterol （LDL）, high density cholesterol （HDL）, apolipoprotein A-I（apoA-I） and apolipoprotein B（apoB） among simple snorer group, mild OSAHS group and moderate to severe OSAHS group （ P 〉 0.05）. Correlation analysis revealed ESS was positively related to AHI （r = 0. 327, P = 0.011）. ESS scores and proportions of hypertension, fasting plasma glucose （FPG） and MS were significantly higher in moderate to severe OSAHS group than those in simple snorer group （P 〈 0.05）. BMI, FPG, TG, proportion of hypertension, ODI and ESS score in MS group were significantly higher than those in non-MS group （ P 〈 0.05）, while there was no significant difference in AHI and LspO2 between these two groups （P 〉 0.05）. Conclusion ESS score may reflect the severity of OSAHS in females. Females with OSAHS matched for age and BMI have no difference in blood fat. With the increase of severity of OSAHS, glycometabolism can be impaired,the prevalences of hypertension and MS increase. MS can exacerbate the severity of OSAHS, indicating that MS and OSAHS interact with each other.