老年患者OSAS严重性与腔隙性脑梗死、脑白质病变及颈动脉硬化发生关系研究

Associations of severity of obstructive sleep apnea syndrome with risks of lacunar infarction, leukodystrophy and carotid atherosclerosis in elderly patients

目的 探讨老年患者阻塞型睡眠呼吸暂停综合征（OSAS）的严重性与腔隙性脑梗死、脑白质病变及颈动脉硬化发生的关系。方法 选择自2010年1月至2013年4月北京大学人民医院老年科收治的107例经睡眠呼吸监测检查证实的老年0SAS患者为病例组，并按照睡眠呼吸暂停低通气指数（AH0分为轻度OSAS组28例、中度OSAS组32例、重度OSAS组47例；选择年龄、性别比例、吸烟、高脂血症患病情况与病例组患者匹配的同期入院查体患者30例为对照组。收集所有入选患者的一般资料，并行头颅CT扫描检查腔隙性脑梗死、脑白质病变情况，行颈动脉超声检查动脉硬化、斑块情况，应用全自动生化分析仪检测血脂、血糖、高敏-C反应蛋白水平。结果 重度OSAS组患者体质量指数、高敏-C反应蛋白水平、糖尿病及高血压发生率明显高于对照组，差异有统计学意义（P〈0．05）。重度OSAS组患者中腔隙性脑梗死发生率（26例，55.3％）、脑白质病变发生率（9例，19．1％）、颈动脉不稳定斑块发生率（30例，63．8％）、颈动脉狭窄发生率（4例，8．5％）明显高于轻度OSAS组（6例，21．4％；1例，3．57％；5例，17．9％；0例，0％）和对照组（4例，13.3％；0例，0％；3例，10．0％；0例，0％），差异均有统计学意义（P〈0．05）。结论 老年严重0SAS患者更易发生腔隙性脑梗死、脑白质病变及颈动脉不稳定斑块。

Objective To analyze the correlations of severity of obstructive sleep apnea syndrome （OSAS） with the prevalence of lacunar infarction, leukoencephalopathy and carotid arteries atherosclerosis in the elderly patients. Methods One hundred and seven polysomnography-confirmed elderly OSAS patients, admitted to our hospital from January 2010 to April 2013, were chosen in our study; according to the apnea hypopnea index, these patients were subdivided into mild OSAS group （n=28）, moderate OSAS group （n=32） and severe OSAS group （n=47）; and other 30 clinical data （age, gender, smoking and hyperlipemia histories）-matched patients, collected at the same time period, were used as controls. The plaques of carotid arteries were detected by high resolution ultrasound, while the cerebrovascular lesions were detected by CT in all patients and controls; the levels of high-sensitivity C-reactive protein （hs-CRP）, glucose and lipids were tested. Results The patients with severe OSAS had higher body mass index, higher rates of hypertension and hyperglycemia, and higher hs-CRP level than control subjects （P〈0.05）. Patients with severe OSAS had higher prevalence of lacunar infarction （n=26, 55.3%）, leukoencephalopathy （n=9, 19.1%）, unstable carotid arteries atherosclerosis （n=30, 63.8%） and carotid stenosis （n=4, 8.5%） than mild OSAS group （n=6, 21.4%; n=l, 3.57%; n=5, 17.9%; n=0, 0%） and control subjects （n=4, 13.3%; n=0, 0%; n=3, 10.0%; n=0, 0%）. Conclusions Patients with severe OSAS have higher prevalence of lacunar infarction, leukoencephalopathy and unstable carotid arteries atherosclerosis.