高血压患者阻塞性睡眠呼吸暂停综合征的临床观察

Clinical Investigation on the Relationship Between Obstructive Sleep Apnea Syndrome and Obesity in Patients With Hypertension

目的:通过观察高血压患者的阻塞性睡眠呼吸暂停综合征(OSAS)的临床表现,旨在探讨不同体重对OSAS的影响。方法:选择269例有打鼾史的高血压患者,进行夜间多导联睡眠图监测。根据体重指数(BMI)分成3组:正常体重组40例,年龄(51.8±11.3)岁,体重指数(23.3±1.0)kg/m2;超重组77例,年龄(49.5±10.2)岁,体重指数(26.0±0.8)kg/m2;肥胖组152例,年龄(46.2±9.8)岁,体重指数(30.6±2.7)kg/m2。所有患者均测量身高、体重、腰围、血压、血脂、空腹血糖、空腹胰岛素、血肌酐,进行各组间各变量比较分析。结果:①269例打鼾的高血压患者中,82.5%(222例)表现为OSAS,单纯鼾症者占17.5%(47例);OSAS患者中男性占80.2%(178例),体重正常者占14.9%(33例),超重者占26.6%(59例),肥胖者占58.6%(130例)。②3组中OSAS严重程度分布不均,正常体重组主要为轻度OSAS(40%),超重组主要为中度OSAS(37.7%),肥胖组主要为重度OSAS(32.9%),差异有统计学意义(P<0.05)。③肥胖组的舒张压、腰围、体重指数、睡眠呼吸暂停低通气指数(AHI)均明显高于正常体重组和超重组,年龄、最低氧饱和度均明显低于正常体重组和超重组,高密度脂蛋白胆固醇明显低于正常体重组,差异均有统计学意义(P<0.05～0.01)。④多元回归分析表明:收缩压或舒张压均与AHI和腰围呈正相关。AHI与腰围、稳态模式评估法的胰岛素抵抗指数(HOMA-IR)呈正相关;最低氧饱和度与腰围、HOMA-IR呈负相关。结论:肥胖是高血压独立危险因素,也是OSAS发病的重要原因之一。体重越重,OSAS的严重程度越明显。

Objective：To investigate the relationship between obstructive sleep apnea syndrome（OSAS） and obesity in patients with hypertension. Methods：We recruited 269 patients with OSAS and hypertension for polysomnography. OSAS was defined as an apnea-hy- popnea index（AHI） ≥ 5 events/hour. The patients were divided into three groups according to body mass index （BMI）. Control group,n =d0,the patients had the average BMI at（23.3 ± 1.0）kg/m^2 with the average age of（51.8 ± 11.3）years old; Over weight group,n =77,the patients had the average BMI at（26. 0 ±0. 8） kg/m^2 with the average age of（49. 5 ± 10. 2） years and Obesity group ,n = 152 ,the patients had the average BMI at（ 30. 6 ±2. 7 ）kg/m^2 with the average age of（ 46. 2 ± 9. 8 ）years. The body weight, height, waist circumference （ WC ） , systolic blood pressure （SBP） , diastolic blood pressure （DBP） , plasma creatinine （ Cr）, fasting plasma glucose （FPG） and insulin （ Fins ）, total cholesterol （ TC ）, high density lipoprotein cholesterol （ HDL ）, low density lipoprotein cholesterol（LDL） and triglyceride（TG） were examined in all patients and compared between different groups. Results ：（2）There were 82. 5% （222/269）patients suffered from OSAS and 80. 2% （178/222）of them were male. The Control group contained 14.9% （33/222）of OSAS, the Over weight group contained 26. 6% （59/222） , and the Obesity group contained 58.6% （130/222）. （2）The severity of OSAS was different in each group. There were more mild OSAS found in Control group, moremoderate OSAS found in Over weight group, and more severe OSAS found in Obesity group （P 〈 0. 05 ）. （3）In Obesity group, DBP, WC and AHI were higher than that in Control group and Over weight group. （P 〈 0. 05 respectively） , while the age and the minimum oxygen saturation（ MSpO2 ）were lower than that in Control and Over weight group, and HDL was obviously lower than that in Control group（ P 〈 0. 05 -0.01, respectively）. （4）Muhiple linear regression analysis indicated that SBP or DBP was positively related to AHI and WC, AHI was positively related to WC and homeostasis model assessmeut-insulin resistance（HOMA-IR） ;while MSpO2 was negatively related to WC and HOMA-IR. Conclusion ： Obesity was not only the independent risk factor of hypertension, but also one of the important causes for OSAS. The severity of BMI was strongly linked to OSAS development.