阻塞性睡眠呼吸暂停低通气综合征合并高血压的特点及危险因素

Analysis of clinical characteristics and risk factors of obstructive sleep apnea hypopnea syndrome with hypertension

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压的临床特点及形成高血压的危险因素。 方法收集从2012年7月至2015年8月在广西睡眠呼吸疾病诊疗中心就诊的2 397例年龄≥30岁的OSAHS患者，从中选择新发OSAHS合并高血压（合并高血压组）及单纯OSAHS患者（单纯OSAHS组）临床资料，包括人口学资料、高血压和打鼾家族史、Epworth嗜睡量表（ESS）评分、一般体格检查数据及多导睡眠图（PSG）监测指标等。按照年龄和体质指数（BMI）匹配（同一匹配受试者间年龄相差〈2岁，BMI相差〈1.5 kg/m2）纳入合并高血压组101例和单纯OSAHS组202例。采用病例对照研究方法，比较两组患者临床特点并运用单因素与多因素Logistic回归法分析OSAHS患者形成高血压除年龄和BMI外的其他重要影响因素。 结果合并高血压组、单纯OSAHS组的平均年龄和BMI分别为（46.2±9.3）、（46.2±9.2）岁和（28.2±2.8）、（28.2±2.8）kg/m2，匹配良好（均P〉0.05）；合并高血压组就诊时、睡前、醒后收缩压与舒张压均显著高于单纯OSAHS组（均P〈0.001）；合并高血压组和单纯OSAHS组的ESS评分分别为10.0±6.4和9.2±6.3（P〉0.05），颈围、腰围、打鼾年限、打鼾家族史、高血压家族史差异也均无统计学意义（均P〉0.05）。合并高血压组睡眠呼吸暂停低通气指数（AHI）、呼吸暂停指数（AI）均显著高于单纯OSAHS组（均P〈0.05）；最长呼吸暂停时间（LAD）、平均呼吸暂停时间（MAD）、血氧饱和度（SpO2）〈90%累计时间（T90%）均显著长于单纯OSAHS组（均P〈0.05）；最低SpO2显著低于单纯OSAHS组（P〈0.05）。单因素Logistic回归分析有6个因素与OSAHS患者高血压的发生相关：AHI（OR＝0.985，P＝0.001）、AI（OR＝0.983，P〈0.001）、LAD（OR＝0.955，P＝0.013）、MAD（OR＝0.874，P＝0.015）、最低SpO2（OR＝0.874，P＝0.015）、T90%（OR＝0.997，P＝0.036）。多因素Logistic回归分析仅最低SpO2在模型中与OSAHS高血压的形成密切相关（OR＝0.894，P〈0.001）。 结论OSAHS合并高血压患者较单纯OSAHS患者具有更低的最低SpO2，更高的AHI、AI以及更长的LAD、MAD和T90%；最低SpO2可能是除年龄和BMI外，OSAHS高血压形成的密切相关因素。

ObjectiveTo study the risk factors contributing to the development of hypertension in patients with obstructive sleep apnoea hypopnea syndrome （OSAHS）, and the clinical characteristics of OSAHS with hypertension. MethodsA total of 2 397 OSAHS patients aged above 30 years old and diagnosed by the sleep-disordered breathing center of Guangxi between July 2012 and August 2015 were recruited. OSAHS patients with new-onset hypertension （OSAHS with hypertension group） and those without hypertension （simple OSAHS group） were identified and their clinical data, including general status, family history of hypertension or snoring, Epworth Sleepiness Scale （ESS） score for daytime sleepiness, physical examination findings, and polysomnography monitoring data were collected. OSAHS patients with new-onset hypertension （n=101） and OSAHS patients without hypertension （n=202） matched by age and body mass index （BMI） （age difference, 2 years; BMI difference, 1.5 kg/m2） were recruited in the OSAHS with hypertension group and the simple OSAHS group. A case-control study was used to compare the clinical characteristics of these two groups, and univariate and multivariate Logistic regression were used to analyze all the factors contributing to hypertension development besides age and BMI. ResultsThe average age and BMI of the OSAHS with hypertension group and the simple OSAHS group were respectively （46.2±9.3）, （46.2±9.2） years old and （28.2±2.8）, （28.2±2.8） kg/m2. Patients in the two groups were well-matched with respect to age and BMI （P〉0.05）. The systolic blood pressure （SBP） and diastolic blood pressure （DBP） in the OSAHS with hypertension group were significantly higher than those in the simple OSAHS group at the first admission to the clinic and before and after the PSG examination. ESS values in the OSAHS with hypertension group and the simple OSAHS group were respectively 10.0±6.4 and 9.2±6.3 （P〉0.05）. There was no significant intergroup difference in neck circumference, waist circumference, duration of snoring, family history of snoring, and family history of hypertension （P〉0.05） either. The apnea-hypopnea index （AHI） and apnea index （AI） in the OSAHS with hypertension group were higher than those in the simple OSAHS group （P〈0.05）; the longest apnea duration （LAD）, mean apnea duration （MAD）, and the total time spent with oxygen saturation below 90% （T90%） in the OSAHS with hypertension group were significantly longer than those in the simple OSAHS group （P〈0.05）. The minimal pulse oxygen saturation （MinSpO2） in the OSAHS with hypertension group was significantly lower than that in the simple OSAHS group （P〈0.05）. Six factors were identified to be associated with OSAHS with hypertension through univariate analysis： AHI （OR=0.985, P=0.001）, AI （OR=0.983, P〈0.001）, LAD （OR=0.955, P=0.013）, MAD （OR=0.874, P=0.015）, MinSpO2 （OR=0.874, P=0.015）, T90% （OR=0.997, P=0.036）. Only MinSpO2 （P〈0.001, OR=0.894） was closely related to OSAHS hypertension development in the multivariate Logistic regression model. ConclusionsOSAHS patients with hypertension may show lower MinSpO2, higher AHI and AI, and longer LAD, MAD, and T90% than OSAHS patients without hypertension. MinSpO2 is probably closely related to OSAHS hypertension development.