阻塞性睡眠呼吸暂停低通气综合征合并高血压患者皮质下觉醒反应与糖代谢相关性研究

Relationship between subcortical arousal and glucose metabolism in patients with obstructive sleep apnea hypopnea syndrome and hypertension

目的探讨皮质下觉醒反应对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者糖代谢影响。方法选择2015年10月—2016年5月新疆维吾尔自治区人民医院高血压中心住院患者102例,所有患者均行夜间多导睡眠监测、空腹血糖、糖化血红蛋白(Hb A1c)和脉搏传导时间(PTT)测定。根据呼吸暂停低通气指数(AHI),研究对象分为轻、中和重度OSAHS合并高血压组和高血压对照组。各组间睡眠监测相关参数、PTT觉醒指数、空腹血糖和Hb A1c的比较采用方差分析;糖代谢紊乱的影响因素分析采用逐步线性回归分析。结果在中重度OSAHS患者中PTT觉醒指数明显增加,同时重度OSAHS组空腹血糖明显增加。Hb A1c虽然随OSAHS严重程度增加有逐渐增高的趋势,但差异无统计学意义。相关分析显示空腹血糖与PTT觉醒指数和氧减指数之间呈正相关(r=0.253,P=0.014;r=0.242,P=0.015);Hb A1c与PTT觉醒指数之间呈正相关(r=0.326,P=0.001)。逐步多元线性回归纳入糖代谢相关危险因素包括年龄、肥胖、AHI、最低血氧饱和度、氧减指数、脑电觉醒指数和PTT觉醒指数,结果显示在矫正上述混杂因素后,PTT觉醒指数是空腹血糖的独立影响因素(β=0.007,P=0.018);年龄和PTT觉醒指数是Hb A1c的独立影响因素(β=0.018,P=0.037;β=0.005,P=0.040)。结论中重度OSAHS合并高血压患者皮质下觉醒反应明显增加,这可能是OSAHS合并高血压患者发生糖代谢紊乱的机制之一。中重度OSAHS合并高血压患者应该常规筛查糖代谢紊乱。

Objective To investigate the effect of subcortical arousal response on glucose metabolism in patients with essential hypertension and obstructive sleep apnea hyponea syndrome （OSAHS）. Methods Between October, 2015 to May, 2016, 102 patients meeting the diagnostic criteria were selected in the center of hypertension of the People＇ s Hospital of Xinjiang Uygnr Autonomous Region. All patients underwent nocturnal polysomnography and fasting blood glucose （ FBG）, glycosylated hemoglobin （HbAlc） and pulse transit time （PTF） determination. According to the apnea hypopnea index （AHI）, the subjects were divided into two groups： hypertension control group and hypertension combined with OSAHS group （further divided into 3 subgroups： mild, moderate and severe）. The parameters of OSAHS, PTT, FBG and HbAlc were compared among groups, and the influence factors of glucose metabolism disorder were analyzed by stepwise regression analysis. Results In the moderate and severe OSAHS with hypertensive groups, PTT arousal index increased significantly compared with mild OSAHS and control group. In the severe OSAHS group FBG significantly increased than that in other groups. Correlation analysis showed that FBG was positively correlated with PTF arousal index （ r = 0. 253, P = 0.014） and oxygen desaturation index （r =0.242, P =0. 015） ; HbAlc were positively correlated with PTT arousal index （r = 0. 326, P =0. 001 ）. Stepwise multiple linear regression analysis showed that PIT arousal index was the independent factor of FBG （13 =0.007, P=0.018） ; age and PTT arousal index were independent factors of HbAlc （43 =0. 018, P =0. 037; β = 0. 005, P = 0. 040 respectively）. Conclusion There is a significant increase in subcortical arousal in moderate and severe OSAHS with hypertension patients, which may be one of the mechanisms of glucose metabolism disorder. Glucose metabolism disorders should be routinely screened in patients with OSAHS and hypertension.