脑卒中危险度与阻塞性睡眠呼吸暂停低通气综合征的关系研究

Relationship between Stroke Risk and Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨脑卒中危险度与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的关系,寻找具有预测价值的指标,为准确防治OSAHS可能发生脑卒中事件提供依据。方法对130例OSAHS患者进行Essen脑卒中风险评分,根据评分将入组OSAHS患者分为低危组、非低危组(高危及极高危组)。分析比较两组患者相关临床指标(性别、年龄、吸烟系数、血压、体质指数、血糖、血尿酸、动脉血气指标、肺功能指标及多导睡眠监测指标);并对差异有统计学意义的指标进行多元线性回归分析,探讨其对Essen脑卒中风险评分的影响。结果低危组OSAHS患者年龄、吸烟系数、收缩压、血糖与非低危组比较,差异均有统计学意义(P<0.05)。两组患者性别构成、体质指数、舒张压、血尿酸比较,差异均无统计学意义(P>0.05)。低危组OSAHS患者动脉血氧饱和度(SaO2)、血二氧化碳分压(PaCO2)、肺容量(VC)、每分钟最大通气量(MVV)、呼气高峰流量(PEF)、一秒用力呼气量(FEV1)、用力肺活量(FVC)与非低危组比较,差异均有统计学意义(P<0.05)。两组患者血氧分压(PaO2)、FEV1预计值(%)、FVC预计值(%)、FEV1/FVC(%)比较,差异均无统计学意义(P>0.05)。低危组OSAHS患者紊乱次数、AHI、最长暂停时间、最低SaO2、SaO2<90%占总睡眠时间百分比比较,差异均有统计学意义(P<0.05)。两组患者平均最低SaO2、不同严重度0SAHS构成比较,差异均无统计学意义(P>0.05)。轻度OSAHS患者体质指数与中重度患者比较,差异有统计学意义(P<0.05)。两组性别构成、年龄、吸烟系数、血糖、血尿酸、Essen脑卒中危险评分及不同脑卒中危险度构成比较,差异均无统计学意义(P>0.05)。以Essen脑卒中危险评分为因变量,其与多导睡眠监测指标中的SaO2<90%占总睡眠时间百分比(r=0.011,P=0.043)、年龄(r=0.087,P=0.000)、吸烟系数(r=0.001,P=0.003)、VC(r=0.265,P=0.043)均呈正相关。结论 OSAHS患者Essen脑卒中风险评分越高,低氧、睡眠呼吸暂停越明显,肺功能越差;除传统脑卒中风险因素外,OSAHS患者脑卒中发生风险与反复的低氧状态有关,VC、SaO2<90%占总睡眠时间百分比为具有重要风险预测价值的指标。

Objective To investigate the relationship between the risk of stroke and obstructive sleep apnea hypopnea syndrome （OSAHS） and to find predictive factors to provide evidence for the prevention and treatment of stroke that may occur in OSAHS patients. Methods 130 OSAHS patients were divided into low risk group and non - low risk group （ high risk group and extremely high risk group） according to Essen Stroke Risk Score. Clinical indexes （gender, age, smoking coefficient, blood pressure, body mass index, blood glucose, blood uric acid, arterial blood gases, lung function index and polysomnography in- dexes） were analyzed and compared between the two groups. Multiple linear regression analysis was performed on indexes withstatistical significance to discuss their influence on Essen Stroke Risk Score. Results The age, smoking coefficient, systolic pressure and blood glucose between the low risk group and non - risk group showed statistically significant differences （ P 〈 0. 05 ）. While the sex composition, body mass index, diastolic blood pressure and blood uric acid showed no statistically signifi- cant differences between the two groups （P 〉 0. 05）. The SaO2, PaCO2, VC, MVV, PEF, FEVI and FVC between the low risk group and non - low risk group showed statistically significant differences （P 〈 0.05 ）. While the PaO2, FEVI predicted val- ue （%）, FVC predicted value （%） and FEV,/FVC （%） between the two groups showed no statistically significant differences （P 〉0.05）. The frequency of total disorder, AHI, apnea time, lowest SaO2 and the percentage of SaO2 〈90% accounting for the total sleep time showed statistically significant differences （P 〈 O. 05 ）. The mean lowest SaO2 and composition of different levels of OSAHS showed no statistically significant differences between low risk group and non - low risk group （P 〉 0. 05）. The body mass index showed statistically significant difference between mild OSAHS patients and moderate to severe OSAHS patients （P 〈 0.05 ）. But the two groups showed no statistically significant differences in sex composition, age, smoking coefficient, blood glucose, blood uric acid, Essen stroke risk score and composition of different levels of OSAHS （P 〉 0. 05）. Multiple lin- ear regression analysis showed that Essen stroke risk score was positively correlated with SaO2 〈 90% accounting for the total sleep time （r=0.011, P=0.043）, age （r =0.087, P=O. 000）, smoking coefficient （r=0.001, P=0.003） and VC （r= O. 265, P = 0. 043）. Conclusion The higher the Essen stroke risk score is, the more obvious the hypoxia and apnea and the worse the lung function will be. The incidence of stoke in OSAHS patients was related to the repeated hypoxia. VC and the per centage of SaO： 〈 90% accounting for the total sleep time is of great value in predicting the risk.