睡眠呼吸暂停人群中血清甲状腺功能指标变化的探讨

Changes of Serum Thyroid Function Indicators in People with Sleep Apnea

目的通过评价阻塞性睡眠呼吸暂停(OSA)患者的血清TSH水平及其与相关危险因素的关系,探讨OSA患者甲状腺功能变化的可能原因。方法横断面研究,对2015年12月-2017年12月期间连续住院的疑似OSA患者进行多导睡眠监测(PSG)并诊断,据其呼吸暂停低通气指数(AHI)进行分组;同时用电化学发光法检测其血清甲状腺功能指标。结果本研究最终纳入350例,其中248例(71.0%)被诊断有OSA其AHI≥5。OSA患者亚临床甲状腺功能减退症检出率明显高于非OSA对照人群其AHI<5(16.5%vs 6.9%),并有统计学意义(χ^2=5.71,P=0.017)。AHI≥30的重度OSA患者的血清促甲状腺激素(LnTSH)水平明显高于非OSA对照组,且有统计学意义(0.98±0.32 vs 0.72±0.50,P <0.05)。AHI与血清TSH水平之间存在正相关性(r=0.263,P=0.017),最低氧饱和度与血清TSH水平间存在负相关性(r=-0.250,P=0.036),均有统计学意义,且多元回归分析显示以上相关性独立于年龄,性别,体重指数,血压等混杂因素。结论 OSA可能是TSH水平升高的独立危险因素,有必要对OSA患者进行甲状腺功能检测。

Objective To explore the changes in serum levels of thyroid stimulating hormone(TSH)in patients with obstructive sleep apnea(OSA) and related factors. Methods This is a cross-sectional study. A group of subjects were enrolled consecutively between 2015/12 and 2017/12, based on the inclusion and exclusion criteria. All the subjects underwent polysomnography to determine whether presence of OSA or not. Meanwhile, the serum thyroid function was tested using Electrochemiluminescence technique. Results 350 subjects were enrolled for the study, of whom AHI≥5 and OSA was diagnosed in 248(71%)subjects. Prevalence of subclinical hypothyroidism was significantly higher in OSA subjects than in non-OSA subjects who AHI<5(6.9% vs 16.5%, 2=5.71, P = 0.017).Serum Ln thyroid stimulating hormone(TSH)was significantly higher in severe OSA group of whom AHI≥30 than in non-OSA group(0.98±0.32 vs 0.72±0.50, P < 0.05). LnTSH showed a significant positive correlation with AHI(r = 0.263,P = 0.017)and a negative correlation with lowest saturation of oxygen(r =-0.250, P = 0.036)and independent of confounding factors such as age, gender, body mass index and blood pressure. Conclusion OSA might be a risk factor for elevated serum TSH, indicating OSA patient should be screened for thyroid function test, whereas this needs confirmation from cohort studies.