绝经女性高血压患者阻塞性睡眠呼吸暂停综合征发生情况及相关危险因素

Obstructive sleep apnea syndrome in postmenopausal female hypertensive patients and its related risk factors

目的探讨绝经女性高血压患者阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)发生情况及相关危险因素。方法女性高血压患者549例,其中绝经女性280例为绝经组,未绝经女性269例为未绝经组,比较2组一般资料、血脂、C反应蛋白、脂蛋白A、空腹血糖以及2型糖尿病患病率;行多导睡眠呼吸监测,比较OSAS患病率及睡眠参数差异;将绝经组患者分为有OSAS组和无OSAS组,比较2组临床资料,多因素logistic回归分析女性高血压患者绝经后发生OSAS的危险因素。结果绝经组年龄[(56.4±8.2)岁]、体质量指数[27.3(24.8,30.5)kg/m^2]、腹围[98(90,104)cm]较未绝经组[(42.9±6.6)岁、26.6(24.3,29.3)kg/m^2、93(86,98)cm]大,舒张压[(88.3±11.9)mm Hg]较未绝经组[(93.6±12.5)mm Hg]低,总胆固醇[4.6(4.0,5.2)mmol/L]、低密度脂蛋白胆固醇[2.7(2.1,3.1)mmol/L]、三酰甘油[1.7(1.3,2.5)mmol/L]、C反应蛋白[1.2(0.6,2.5)mmol/L]、空腹血糖[5.1(4.6,5.7)mmol/L]、果糖胺[1.8(1.6,2.2)mmol/L]较未绝经组[4.3(3.7,4.8)、2.4(2.0,2.8)、1.5(1.1,2.2)、1.0(0.5,1.9)、4.7(4.5,5.1)、1.6(1.5,1.8)mmol/L]高,2型糖尿病、OSAS患病率(23.2%、81.4%)较未绝经组(4.8%、52.4%)高(P<0.05);绝经组总睡眠时间[373.5(317.5,426.0)min]较未绝经组[404.8(343.0,441.0)min]少,平均血氧饱和度[91(90,93)%]、最低血氧饱和度[77(70,82)%]、心率[65(60,71)次/min]、睡眠效率[72.3(61.6,80.3)%]、非快速动眼睡眠期4期[5.7(0,11.0)%]、氧减饱和指数3[20.0(10.1,31.0)%]较未绝经组[93(92,94)%、79(74,83)%、68(64,74)次/min、74.8(66.0,83.4)%、7.1(2.5,13.1)%、36.6(21.0,55.1)%]低,呼吸暂停低通气指数[14.6(6.6,28.0)次/h],呼吸暂停指数[3.6(0.4,14.0)次/h],低通气指数[75(46,140)次/h],氧减饱和指数4[22.1(10.8,37.0)%]较未绝经组[5.4(1.4,12.5)次/h、1.4(0.1,8.0)次/h、57(39,94)次/h、9.7(4.3,19.0)%]高(P<0.05);绝经组吸烟、饮酒、打鼾比率以及收缩压、高密度脂蛋白胆固醇、脂蛋白A水平,非快速动眼睡眠1、2、3期,快速动眼睡眠期与未绝经组比较差异无统计学意义(P>0.05);绝经组有OSAS者年龄[(57.0±8.3)岁]、腹围[98(90,106)cm]、体质量指数[28.0(25.4,31.2)kg/m^2]较无OSAS者[(53.6±7.0)岁、[91(83,99)cm]、[25.2(22.8,27.7)kg/m^2]大,收缩压[140(130,155)mm Hg]、舒张压[90(80,100)mm Hg]、果糖胺[1.8(1.6,2.2)mmol/L]较无OSAS组[131(120,149)mm Hg、85(80,90)mm Hg、1.7(1.5,1.9)mmol/L]高(P<0.05);多因素logistic回归分析结果显示,果糖胺≥1.8mmol/L(OR=2.014,95%CI:1.061~3.821,P=0.032)、年龄≥56岁(OR=1.972,95%CI:1.042~3.731,P=0.037)、腹围≥98cm(OR=2.827,95%CI:1.451~5.506,P=0.002)是绝经后女性高血压患者发生OSAS的危险因素。结论女性高血压患者随年龄增长,糖脂代谢发生紊乱,OSAS、2型糖尿病患病率增高,果糖胺水平增高、腹围增大是其发生OSAS的危险因素。

Objective To investigate the development of obstructive sleep apnea syndrome(OSAS)in postmenopausal female hypertensive patients and its related risk factors.Methods Totally 549female hypertensive patients,including 280postmenopausal patients(postmenopausal group)and 269premenopausal patients(premenopausal group),were analyzed the general data,blood lipid,C-reactive protein,lipoprotein A,fasting plasma glucose,and incidence of type 2 diabetes mellitus.Polysomnography was performed to compare the incidence of OSAS and the difference in sleep parameters.Postmenopausal group was divided into OSAS group and non-OSAS group,and the general clinical data were compared between two groups.Multivariate logistic regression analysis was used to study the risk factors for OSAS in postmenopausal female hypertensive patients.Results Postmenopausal group had older age((56.4±8.2)years),larger body mass index(27.3(24.8,30.5)kg/m^2),larger abdominal circumference(98(90,104)cm),lower diastolic blood pressure((88.3±11.9)mm Hg),higher levels of total cholesterol(4.6(4.0,5.2)mmol/L),low-density lipoprotein cholesterol(2.7(2.1,3.1)mmol/L),triacylglycerol(1.7(1.3,2.5)mmol/L),C-reactive protein(1.2(0.6,2.5)mmol/L),fasting plasma glucose(5.1(4.6,5.7)mmol/L)and fructosamine(1.8(1.6,2.2)mmol/L),and higher incidences of type 2diabetes mellitus and OSAS(23.2%,81.4%)than premenopausal group((42.9±6.6)years,26.6(24.3,29.3)kg/m^2,93(86,98)cm,(93.6±12.5)mm Hg,4.3(3.7,4.8)mmol/L,2.4(2.0,2.8)mmol/L,1.5(1.1,2.2)mmol/L,1.0(0.5,1.9)mmol/L,4.7(4.5,5.1)mmol/L,1.6(1.5,1.8)mmol/L,4.8%,52.4%)(P<0.05).The total sleep time(373.5(317.5,426.0)min)was shorter,and the mean oxygen saturation(91(90,93)%),the lowest oxyhemoglobin saturation(77(70,82)%),the heart rate(65(60,71)beat/min),the sleep efficiency(72.3(61.6,80.3)%),non-rapid eye movement sleep phase 4(5.7(0,11.0)%)and oxygen desaturation index 3(20.0(10.1,31.0)%)were significantly lower in postmenopausal group than those in premenopausal group(404.8(343.0,441.0)min,93(92,94)%,79(74,83)%,68(64,74)beat/min,74.8(66.0,83.4)%,7.1(2.5,13.1)%,36.6(21.0,55.1)%),while apnea hypopnea index(14.6(6.6,28.0)times/h),breathing suspension index(3.6(0.4,14.0)times/h),hypopnea index(75(46,140)times/h)and oxygen desaturation index 4(22.1(10.8,37.0)%)in postmenopausal group were significantly higher than those in premenopausal group(5.4(1.4,12.5)times/h,1.4(0.1,8.0)times/h,57(39,94)times/h,9.7(4.3,19.0)%)(P<0.05).The percentages of smoking,alcohol consumption and snoring,the levels of systolic blood pressure,high-density lipoprotein cholesterol and lipoprotein A,as well as nonrapid eye movement sleep period 1,2and 3,and rapid eye movement sleep period showed no significant differences between postmenopausal group and premenopausal group(P>0.05).OSAS group had older age((57.0±8.3)years),larger abdominal circumference(98(90,106)cm),larger body mass index(28.0(25.4,31.2)kg/m^2),higher systolic blood pressure(140(130,155)mm Hg),diastolic blood pressure(90(80,100)mm Hg)and fructosamine(1.8(1.6,2.2)mmol/L)than non-OSAS group((53.6±7.0)years,91(83,99)cm,25.2(22.8,27.7)kg/m^2,131(120,149)mm Hg,85(80,90)mm Hg,1.7(1.5,1.9)mmol/L)(P<0.05).Multivariate logistic regression analysis showed fructosamine≥1.8mmol/L(OR=2.014,95%CI:1.061-3.821,P=0.032),age≥56years(OR=1.972,95%CI:1.042-3.731,P=0.037),and abdominal circumference≥98cm(OR=2.827,95%CI:1.451-5.506,P=0.002)were the risk factors for OSAS in postmenopausal hypertensive women.Conclusion Abnormal glucose metabolism commonly occurs in postmenopausal female hypertensive patients,and the incidences of OSAS and type 2diabetes mellitus are high.High level of fructosamine and increase of abdominal circumference are the risk factors for OSAS.