持续气道正压通气对严重阻塞性睡眠呼吸暂停综合征患者心血管疾病风险的影响

Effects of continuous positive airway pressure on cardiovascular disease riskin patients with severe obstructive sleep apnea syndrome

目的初步探讨持续气道正压通气(CPAP)治疗对严重阻塞性睡眠呼吸暂停综合征(OSAS)患者炎症因子水平和心血管疾病(CVD)风险的影响。方法选取经多导睡眠图(PSG)确诊的严重OSAS患者[睡眠呼吸暂停低通气指数(AHI)≥30次/h]50例。分别记录CPAP治疗前及治疗10周后受试者的ESS评分、血压、呼吸暂停低通气指数(AHI)及脉搏血氧饱和度(Sp O2)、空腹血糖、血清胰岛素、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、纤维蛋白原及TNF-α、SCD40L水平。以稳态模式评估胰岛素抵抗(HOMA-IR)。心血管疾病风险评估根据性别特异的多变量的风险因素算法计算。CPAP治疗1 0周后根据CPAP治疗时间分为2组:依从性好组(≥4 h/晚)及依从性差组(<4 h/晚)。结果在使用CPAP≥4 h/晚(n=33)的患者可以发现收缩压、舒张压、总胆固醇、甘油三酯、空腹血糖、空腹胰岛素、HOMA-IR、TNF-α、SCD40L水平在治疗后下降,与心血管疾病风险下降相关。而在CPAP治疗<4 h/晚组患者中未发现上述改变。总体的依从性与心血管疾病风险及系统炎症的降低呈直线相关。BMI和面罩漏气可能是预测治疗依从性的可靠因素。结论有效的CPAP治疗可以降低严重OSAS患者的血压、血脂、TNF-α、SCD40L水平,提高胰岛素敏感性,降低患心血管疾病的风险。

Objective To investigate the effects of continuous positive airway pressure （CPAP） on inflammatory factor level and cardiovascular diseases （CVD） risk in patients with severe obstructive sleep apnea syndrome （OSAS）. Methods Fifty patients diagnosed as severe OSAS [ apne- a hypopnea index （AHI） I〉30 tiems/h] by polysomnography （PSG） were recruited in this study. In all patients, age, gender, height, weight, neck circumference, waist circumference, smoking or not, past medical history, drug use were registered, and conventional pulmonary function test, ESS score, blood pressure, apnea-hypopnea index （AHI）, oxygen saturation by pulse oximetry （Sp02）, fasting blood glucose, fasting serum insulin, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fibrinogen, TNF-α and SCD40L were measured at baseline and after 10 weeks of CPAP. The insulin resistance index （ homeostasis model assessment [ HOMA-IR] ） was based on the homeostasis model assessment method. The CVD risk was calculated using the multivariable risk factor algorithm. After ten weeks, all subjects were divided into two groups according to time of CPAP therapy： compliant group （t〉4 h/night） and noncompliant group（ 〈4 h/night）. Results CPAP therapy reduced systolic BP , diastolic BP , total cholesterol , triglycerides , fasting serum glucose, fasting serum insulin, HOMA-IR,TNF-cxand SCD40L in the global CVD risk in a total of 33 patients who used CPAP for≥4 h/night. No significant differences were seen in 17 patients who used CPAP for 〈 4 h/nights. Entire compliance was associated with reductions in CVD risk and systemic inflammation. BMI and mask leak may be the dispensable predictors of compliance with CPAP therapy. Conclusion Effective CPAP therapy can reduce blood pressure, serum lipids, TNF-α and SCD40L level, improve insulin sensitivity, and reduce the global CVD risk of patients with severe OSAS.