阻塞性睡眠呼吸暂停低通气综合征与非心源性缺血性卒中复发关系探讨

Discussion about the Relationship of Obstructive Sleep Apnea Hypopnea Syndromes with the Recurrence of Non-cardiac Ischemic Stroke

目的探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndromes,OSAHS）与非心源性缺血性卒中复发之间的关系。方法本研究为前瞻性观察研究,通过对2008年3月~2011年7月北京市海淀医院神经内科住院治疗的227例新发非心源性缺血性卒中患者发病2周时情况进行分析,依据患者呼吸暂停低通气指数（apnea hypopnea index,AHI）分为四组,分别为单纯非心源性缺血性卒中组（Ⅰ组,n=52）,非心源性缺血性卒中合并轻度OSAHS组（Ⅱ组,n=60）、非心源性缺血性卒中合并中度OSAHS组（Ⅲ组,n=59）、非心源性缺血性卒中合并重度OSAHS组（Ⅳ组,n=56）。收集患者基线资料并记录其相关危险因素如高血压、吸烟等及患者睡眠呼吸监测结果。入组满12个月时对患者进行随访,比较各组间缺血性卒中事件复发情况及影响因素。结果单纯非心源性缺血性卒中组、非心源性缺血性卒中合并轻度OSAHS组、非心源性缺血性卒中合并中度OSAHS组、非心源性缺血性卒中合并重度OSAHS组随访12个月内缺血性卒中复发率分别为3.8%、5.0%、11.9%、16.4%,经卡方检验显示非心源性缺血性卒中合并重度OSAHS组较单纯非心源性缺血性卒中组、非心源性缺血性卒中合并轻度OSAHS组的复发率差异存在显著性（P分别为0.033,0.046）,余各组间复发率比较差异无显著性（P分别为0.768,1.177,0.490,0.123）;将体重指数（body mass index,BMI）、高血压、AHI值、血氧饱和度（oxyhemoglobin saturation,SaO2）纳入多因素Logistic回归分析表明,BM[I优势比（odds ratio,OR）3.126,95%可信区间（confidence interval,CI）2.079~4.700,P〈0.001]、高血压病史（OR 3.258,95%CI 1.308~8.111,P=0.011）、AH（IOR 1.071,95%CI 1.038~1.105,P〈0.001）、SaO2（OR 0.907,95%CI 0.848~0.969,P=0.004）与缺血性卒中复发相关,且为独立危险因素。结论 OSAHS、肥胖、高血压可能是缺血性卒中复发的独立危险因素。

Objective To explore the relationship of the recurrence of non-cardiac ischemic stroke with the severity of obstructive sleep apnea-hypopnea syndromes（OSAHS）.Methods In our prospective observational study,we enrolled 227 patients hospitalized in the Department of Neurology,Beijing Haidian Hospital from March 2008 to July 2011.According to apnea hypopnea index（AHI）,these patients were divided into four groups：pure non-cardiac ischemic stroke group（group Ⅰ,n=52）,non-cardiac ischemic stroke combined with mild OSAHS group（group Ⅱ,n =60）,non-cardiac ischemic stroke combined with moderate OSAHS group（group Ⅲ,n=59）,and non-cardiac ischemic stroke combined with severe OSAHS group（group Ⅳ,n=56）.Then we collected the baseline information,recorded other related risk factors（such as hypertension,smoking history）,and kept the results of polysomnography.The patients were followed up after 12 months.The amounts of ischemic stroke recurrence events and the influencing factors were compared with the results taken previously among different groups using Logistic regression analysis.Results The recurrence rates of pure non-cardiac ischemic stroke group,non-cardiac ischemic stroke combined with mild OSAHS group,non-cardiac ischemic stroke combined with moderate OSAHS group,non-cardiac ischemic stroke combined with severe OSAHS group after one year were 3.8%,5.0%,11.9%,and 16.4%,respectively.The statistics results show that the number of non-cardiac ischemic stroke combined with severe OSAHS group＇s ischemic stroke recurrence events is with significant difference compared with both pure non-cardiac ischemic stroke group and non-cardiac ischemic stroke combined with mild OSAHS group（P =0.033,0.046）.While there is no significant difference observed among the other groups（P =0.768,1.177,0.490,0.123）.According to the Logistic regression analysis,it shows that body mass index（BMI）（odds ratios [OR] 3.126,95% confidence interval [CI] 2.079~4.700,P0.001）,hypertension（OR 3.258,95%CI 1.308~8.111,P =0.011）,AHI（OR 1.071,95%CI 1.038~1.105,P 0.001）,SaO 2（OR 0.907,95%CI 0.848~0.969,P =0.004） are related with the recurrence of ischemic stroke,which are also the independent risk factors at the same time.Conclusion OSAHS,obesity and hypertension are the possible independent risk factors led to the recurrence of non-cardiac ischemic stroke.