非肥胖阻塞性睡眠呼吸暂停综合征患者临床特点及危险因素

The clinical characteristics and risk factors in non-obese patients with obstructive sleep apnea syndrome

目的了解非肥胖阻塞性睡眠呼吸暂停综合征（OSAS）患者睡眠监测参数、血压、血脂水平及其风险因素。方法连续人选2009年1月至2010年12月新疆维吾尔自治区人民医院睡眠中心及高血压中心就诊的非肥胖高血压患者221例，均行多导联睡眠监测，比较元OSAS组（n=87）和合并OSAS组（n=134）患者睡眠参数、血压及代谢指标，Logistic回归分析OSAS的危险因素。结果合并OSAS组年龄[（51．1±11．1）比（43．9±12．6）岁]、颈围[（36．8±3．1）比（35．5±3．O）cm]、呼吸暂停低通气指数[（1,4．3比1．3）次／h]、阻塞平均持续时间[（19．9±13．0）比（6．3±8．4）mini、低密度脂蛋白胆固醇（LDL-C）[（2．6±0．8）比（2．34±0．7）mmol／L]明显高于无OSAS组，而白天、夜间及24h平均心率均明显低于无OSAS组（均P〈0．05）。多因素Logistic回归分析显示，颈围和年龄为非肥胖高血压人群患0SAS的危险因素，其中，颈围≥38cm者患0SAS风险是颈围〈32cm者的5．97倍（95％CI1．61422．09），年龄≥65岁者患OsAs风险是年龄〈35岁者的7．56倍（95％CI1．13～50．52）。结论合并OSAS患者比无OSAS者LDL-C增高，而平均心率减慢。颈围和年龄是非肥胖高血压人群患OSAS的危险因素。

Objective To study the sleep monitoring parameters, the levels of blood pressure and plasma lipid, and the risk factors in non-obese patients with obstructive sleep apnea syndrome （OSAS）. Methods Between January 2009 and December 2010, 221 non-obese patients with hypertension selected from the sleep center and department of hypertension of the People＇s Hospital of Xinxiang Uygur Autonomous Region were divided into non-OSAS group （n=87） and OSAS group （n=134）. All patients underwent polysomonography （PSG）. Sleep parameters, blood pressure levels and metabolic indexes were compared between the two groups. Logistic regression model was used to examine the possible risk factors for OSAS in non-obese subjects. Results The mean age [（51.1 ± 11.1） vs （ 43.9 ± 12.6 ） yearsl, neck circumference [ （ 36.8± 3.1 ） vs （ 35.5 ± 3.0 ） cm], apnea-hypopnea index （AHI） [ （ 14.3 vs 1.3 ） events/h], the duration of the obstruction [ （ 19.9 ± 13.0 ） vs （ 6.3± 8.4 ） mini, LDL-C [ （ 2.6 ±0.8） vs （2.3±0.7） mmol/L] in OSAS group were significantly higher than non-OSAS group. The mean heart rates of daytime, night and the whole day in OSAS group were significantly lower than non-OSAS group （all P〈 0.05）. The multivariate Logistic regression analysis indicated that the age increase and greater neck circumference were important risk factors in non-obese OSAS patients. The risk of OSAS in patients with neck circumference ≥38 cm was 5.97 fold higher in patients with neck circumference〈32 cm （95 %CI 1.61-22.09）, and in patients aged ≥65 years was 7.56 fold higher than patients aged 〈 35 years （95%CI 1.13 - 50.52 ）. Conclusion Com- pared with non-OSAS patient, in non-obese patient with OSAS the LDL-C level is higher while mean heart rate is lower. Increasing age and greater neck circumference may be the risk factors in non-obese OSAS patients.