高血压合并阻塞性睡眠呼吸暂停低通气综合征患者左心室结构与收缩功能的影响因素

Effects of obstructive sleep apnea hypopnea syndrome on the left ventricular structures and systolic function in hypertensive patients

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)在高血压人群左心室结构和收缩功能改变中所起的作用。方法高血压住院患者中,对诉有睡眠时打鼾、白天嗜睡、其他原因不能解释的唇舌发绀、不明原因的高血红蛋白血症及难治性高血压者行多导睡眠监测,根据睡眠呼吸紊乱指数(AHI),660例诊断为OSAHS(AHI≥5)者入选为病例组,进一步分为轻(5≤AHI<15)、中(15≤AHI<30)、重(AHI≥30)3组,AHI<5者为对照组(n=229),心脏超声检查左心室结构与功能,对比各组中的左心室相关参数,用因子分析提取影响左心室结构与功能的公因子,多元线性回归分析影响左心室结构与功能的因素。结果 4组患者中血压、年龄等基线资料不匹配。左心室舒张末期内径(LVIDd)、左心室舒张末期容积(EDV)和左心室质量指数在中、重度组高于对照组(P<0.05);室间隔厚度、左心室后壁厚度和搏出量在OSAHS各组高于对照组(P<0.01)。因子分析纳入可能影响左心室结构与功能的因素,共提取4个公因子:OSAHS、血压、体质量、年龄病程因子;多元线性回归显示OSAHS分别与室间隔厚度(β=0.14,P<0.01)、左心室后壁厚度(β=0.07,P<0.01)和左心室质量指数(β=0.09,P<0.01)相关,室间隔厚度的影响因素依次为血压>性别>体质量>OSAHS>年龄病程,左心室后壁厚度的影响因素为性别>血压>体质量>年龄病程>OSAHS,左心室质量指数的影响因素分别为血压>体质量>年龄病程>性别>OSAHS。左心室收缩末期内径(LVIDs)、LVIDd、EDV和心搏出量分别与血压、性别及体质量相关,与OSAHS无关。结论在高血压合并OSAHS患者中,OSAHS可能是除血压因素外导致高血压患者左心室向心性肥厚的危险因素,该人群左心室收缩功能的改变与血压及体质量相关。

Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome（OSAHS）on the left ventricular（LV）structure and its systolic function in hypertensive patients.Methods Polysomnography（PSG）was performed in 660 hypertensive inpatients complaining of snoring,daytime somnolence,cryptogenic cyanosis of the lips and tongue,hyperhemoglobinemia of unknown aetiology,or with refractory hypertension.All the subjects were divided into three groups according to apnea hypopnea index（AHI）score：mild（AHI 5 to 15/h）,moderate（AHI 15 to 30/h）and severe OSAHS group（greater than 30）.229 hypertensive patients with AHI5/h served as control.The LV structure and its systolic function examined by echocardiogram were compared among the groups.Factor analysis was employed to identify the common factors which could account for the alterations of the LV architecture and function.And multiple linear regression analysis was used to study the influencing factors of the observed variables.Results Baseline data did not match among the four groups.LV internal diameter end-diastolic（LVIDd）,end-diastolic volume（EDV）and Left ventricular mass index（LVMI）increased markedly in moderate and severe groups than those in control（P0.05）.Interventricular septal thickness（IVST）,left ventricular posterior wall thickness（LVPWT）and stroke volume（SV）were significantly higher in all OSAHS groups than those in control group.Factor analysis was performed to test the common factors such as OSAHS,blood pressure（BP）,body mass（BM）,age and course of disease（ACD）,which might influence the structure and function of LV.OSAHS was correlated with IVST（β=0.14,P0.01）,LVPWT（β=0.07,P0.01）and LVMI（β=0.09,P0.01）by multiple linear analysis.The contribution was in the order of BPgenderBMOSAHSACD for IVST,genderBPBMACDOSAHS for LVPWT,and BPBMACDgenderOSAHS for LVMI.The alterations of left ventricular internal diameter end-systolic（LVIDs）,LVIDd,EDV and SV were associated with the factors such as BP,gender and BM,but were no correlated with OSAHS.Conclusion OSAHS may be an independent risk factor contributing to the LV concentric hypertrophy in hypertensive patients.The change of LV systolic function of hypertensive patients with OSAHS may be associated with BP and BM.