阻塞性睡眠呼吸暂停患者肺动脉僵硬度的评价及其与低氧的关系

Evaluation of pulmonary artery stiffness in obstructive sleep apnea and its relationship with hypoxia

目的:旨在研究阻塞性睡眠呼吸暂停患者(OSA)夜间间歇性缺氧程度对肺动脉僵硬度(PAS)和右心室功能的影响。方法:对可疑OSA的患者进行多导睡眠图(PSG)和经胸超声心动图检查(n=376)。按夜间最低脉搏血氧饱和度(SpO2)分为三组(对照组:Sp O2≥90%,轻中度低氧组:80%≤SpO2<90%,重度低氧组:SpO2<80%)。比较三组患者的PAS和右心室功能,并进一步分析其相关影响因素。结果:最终本研究对278例患者进行分析。重度低氧组PAS显著升高(P=0.003),与平均肺动脉压(mPAP)有良好的相关性(r=0.780,P<0.001),而mPAP在不同组间差异无统计学意义(P>0.05)。各组间右心室功能相关参数,差异无统计学意义(P>0.05)。单因素和多因素Logistic分析表明,只有夜间最低SpO2(OR=1.807,P=0.001)是PAS升高的相关因素。结论:在重度低氧血症的OSA患者中PAS增加,仅夜间最低SpO2是其相关因素。

Objective:We aimed to investigate the impact of degree of hypoxia in patients with obstructive sleep apnea(OSA)on pulmonary artery stiffness(PAS)and right ventricular(RV)function.Methods:Polysomnography(PSG)and comprehensive transthoracic echocardiography examination were done in suspected OSA patients(n=376).All subjects were divided into 3 groups according to nocturnal lowest pulse oxygen saturation(SpO2)(Control:SpO2≥90%;Mild-to-Moderate hypoxia:80%≤SpO2<90%and Severe hypoxia:SpO2<80%).PAS and RV function were compared among 3 groups and further analysis its associated factors.Results:A total of 278 patients were finally analyzed.PAS was significantly increase in Severe hypoxia group(P=0.003)and had a good correlation with mean pulmonary artery pressure(m PAP)(r=0.780,P<0.001)while m PAP was similar among different groups.There were no significant difference about RV function related parameters among groups.Uni-and multi-variate Logistic analysis showed that only lowest SpO2(OR=1.807,P=0.001)was an independent associated factor with PAS increase rather than LV function or hypertension.Conclusions:PAS increased in severe hypoxia OSA and only nocturnal lowest SpO2 is an independent associated factor.