282例不同程度阻塞型睡眠呼吸暂停低通气综合征合并高血压患者的临床资料回顾性分析

A retrospective clinical data analysis of 282 patients with obstructive sleep apnea hypopnea syndrome with hypertension

目的探讨不同程度阻塞型睡眠呼吸暂停低通气综合征（0sAHS）合并高血压对代谢、血管结构和功能改变以及夜间睡眠各时期平均心率的影响。方法收集2012—2016年在徐州市中心医院心血管内科住院筛查高血压病因的360例患者的临床资料，根据患者呼吸暂停低通气指数（AHI）分为单纯高血压组（AHI〈5次／h）、高血压合并轻度OSAHS组（AHI5-〈15次／h）、高血压合并中度OSAHS组（AHI16～〈30次／h）和高血压合并重度OSAHS组（AHI〉30次／h）4个组。整理四组患者年龄、腰围、血脂、空腹血糖、空腹胰岛素、超敏C反应蛋白、颈一股动脉脉搏波波速、颈动脉内中膜厚度、夜间多导睡眠监测（PSG）参数等临床资料。运用单因素方差分析及非参数检验上诉因素是否加重OSAHS程度，多重线性回归分析夜间睡眠各期心率与OSAHS的关系。结果重度OSAHS合并高血压组年龄、身体质量指数、腰臀比、腰围身高比、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、超敏C反应蛋白、胰岛素抵抗指数、颈一股动脉脉搏波波速、颈动脉内中膜厚度、AHI、平均血氧饱和度、最低血氧饱和度，以及全程、醒时、睡时、非眼球快速运动睡眠（NREM）期、浅睡期平均心率高于单纯高血压组。多重线性回归分析校正了混杂因素，夜间全程、醒时、睡时、NREM期、浅睡期平均心率都与AHI呈正相关（β=0．344，P=0．000；β=0．490，P=0．000；β=0．300，P=0．001；β=0．306，P=0．001；β=0．293，P=0．001），与年龄呈负相关（β=-0．312，P=0．000；β=-0．345，P=0．000；β=-0．328，P=0．000；β=-0．331，P=0．000；β=-0．331，P=0．000）。结论重度OSAHS加重高血压患者代谢紊乱及血管重构；全程、醒时、睡时、NREM期、浅睡期平均心率随着OSAHS病情加重而升高，随着年龄的增加而减慢。

Objective To explore the influencing factors of vascular structure and function, metabolism and average heart rate in patients with hypertension at night with obstructive sleep apnea hypopnea syndrome （OS- AHS）. Methods A total of 360 patients were hospitalized at the cardiovascular medicine of Xuzhou Central Hos- pital, according to the apnea hypopnea index （AHI） of the patient, the subjects were divided into four groups, which were hypertensive group （AHI〈5 times/h）, hypertension group with mild OSAHS （AHI 5-〈15 times/h）, moderate OSAHS （AHI 16-〈30 times/h） and severe OSAHS （AHI〉30 times/h）. Those groups of clinical data were collected, which including age, waist circumference, persensitive C-reactive protein, carotid-femoral pulse blood lipid, fasting blood glucose, fasting insulin, hy- wave velocity, carotid intima-media thickness and polysomnography （PSG）. One-way ANOVA and nonparametric tests were used to verify they increased OSAHS or not, multiple linear regression were used to analysis the relationship between heart rate and OSAHS during sleep at night. Results The age, body mass index, waist to hip ratio, waist height ratio, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, high sensitivity C-reactive protein, insulin resistance in- dex, the carotid artery-femoral artery pulse wave velocity, carotid intima-media thickness, the AHI, mean blood oxygen saturation, minimum oxygen saturation, average heart rate in full time, awake, sleep, nonrapid eye movement （NREM）, shallow sleep of severe OSAHS combined with hypertension were higher than hypertension group. After correcting the confounding factors by Multiple linear regression analysis, the average heart rate in full time, awake, sleep, NREM, shallow sleep were positively correlated with AHI （β=0.3d4,P=0.000, β=0.490,P=0.000, β=0.300,P=0.001 , β=0.306,P=0.001 , β=0.293,P=0.001）, and negatively correlated with age （β=-0.312, P=0.000, β=-0.345, P=0.000 , β=-0.328, P=0.328, P=0.000, β=-0.331, P=0.000, β=-0.331 , P= 0.000）. Conclusion Severe OSAHS increases the degree of metabolic disorders and vascular remodeling. The average heart rate in full time, awake, sleep, NREM and shallow sleep increases with OSAHS exacerbations, and slows down with age.