老年阻塞性睡眠呼吸暂停综合征与脑卒中的相关性研究

Correlation between obstructive sleep apnea syndrome and ischemic stroke in the elderly

目的探讨老年阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）与脑卒中相关关系和临床特点。方法筛查1658例年龄≥60岁海军离退休干部,非OSAS 1127例,OSAS 531例,其中轻度OSAS 212例,中度OSAS 239例,重度OSAS 80例。非脑卒中1286例,脑卒中372例。收集多导睡眠呼吸监测结果,分析其临床资料和常规生化结果。结果轻度OSAS、中度OSAS、重度OSAS睡眠呼吸暂停低通气指数（AHI）、减氧饱和度指数、平均血氧饱和度及最低血氧饱和度比较差异显著（P〈0.05）。非OSAS受试者合并脑卒中149例（13.2%）,OSAS患者合并脑卒中223例（42.0%）。其中轻度OSAS患者合并脑卒中64例（30.2%）,中度OSAS患者合并脑卒中104例（43.5%）,重度OSAS患者合并脑卒中55例（68.8%）。OSAS患者脑卒中发生率明显高于非OSAS受试者（P〈0.01）。脑卒中患者高血压、糖尿病、AHI、中度OSAS、重度OSAS比例明显高于非脑卒中患者,非OSAS、轻度OSAS比例明显低于非脑卒中患者,差异有统计学意义（P〈0.01）。校正高血压、糖尿病等危险因素后,AHI≥20次/h为脑卒中发病的危险因素（OR=3.106,95%CI：1.583~12.571,P=0.001）。结论 60岁以上老年人OSAS发生率较高,且脑卒中发生率在OSAS患者中明显增加,随着OSAS的严重程度呈递增趋势。

Objective To study the correlation between obstructive sleep apnea syndrome （OSAS） and ischemic stroke in the elderly. Methods A total of 1658 OSAS patients retired from the navy were included in this study. Their clinical and conventional laboratory data were analyzed. Results The AHI, ODI, mean and minimal oxygen saturation were significantly different in mild, moderate and severe OSAS patients. Of the 1658 OSAS patients, 149 （13. 2%） were non-OSAS patients with ischemic stroke,223 （42.0%） were OSAS patients with ischemic stroke [64 （30.2%） were mild OSAS patients with ischemic stroke,104 （43.5%） were moderate OSAS patients with ische- mic stroke,55 （68.8%） were severe OSAS patients with ischemic stroke]. The incidence of ische- mic stroke was significantly higher in OSAS patients than in non-OSAS patients and increased with the severity of OSAS. The ratio of hypertension, AHI,moderate and severe OSAS was sig- nificantly higher while that of non-OSAS and moderate OSAS was significantly lower in ischemic stroke patients than in non-ischemic stroke patients （P〈0.01）. AHI≥20 times/h was the risk factor for ischemic stroke after adjustment for risk factors such as hypertension and diabetes （OR=3.106,95%CI.1.583--12.571,P=0.001）.Conclusion The incidence of OSASis rather high in over 60 years old elderly people and increases with the severity of OSAS.