高血压合并睡眠呼吸暂停低通气综合征患者红细胞分布宽度与睡眠呼吸监测参数的关系分析

Relationship of Red Blood Cell Distribution Width with Polysomnography Parameters in Patients with Hypertension and Sleep Apnea Hypopnea Syndrome

背景目前关于炎性因子和上气道阻塞之间的关系尚存在争议。虽然多导睡眠监测是诊断阻塞性睡眠呼吸暂停综合征(OSAS)的金标准,但是操作复杂、耗时、成本高,不适合反复监测。目的通过回顾性分析高血压合并OSAS患者的相关资料,探讨红细胞分布宽度(RDW-CV)和睡眠呼吸监测参数的关系及RDW-CV的影响因素。方法选取2017—2019年首都医科大学附属北京安贞医院已出院高血压患者287例。入院时收集患者的一般资料(性别、年龄、身高、体质量、吸烟情况、合并心血管疾病情况),检测超敏C反应蛋白(hs-CRP)、RDW-CV,记录氧减指数、最低血氧饱和度和平均血氧饱和度、睡眠呼吸暂停低通气指数(AHI)、24 h平均收缩压(24 hSBP)、24 h平均舒张压(24 hDBP)。依据AHI将合并OSAS患者分为轻、中、重度,AHI为5~15次/h为轻度、16~30次/h为中度、>30次/h为重度。结果未合并OSAS患者62例,合并OSAS患者225例,其中轻度50例,中度78例,重度97例。合并OSAS患者年龄、吸烟比例、合并心血管疾病比例、BMI、24 hSBP、RDW-CV、hs-CRP高于未合并OSAS患者(P<0.05);合并OSAS的患者RDW-CV与年龄、BMI、24 hSBP、氧减指数、AHI和hs-CRP呈正相关,与最低血氧饱和度和平均血氧饱和度呈负相关(P<0.05)。多因素Logistic回归分析发现,年龄、AHI和hs-CRP是RDW-CV的影响因素(P<0.05)。结论 RDW-CV与高血压合并OSAS患者睡眠呼吸监测参数相关,可能可以作为一种新型的监测指标,而且容易测量。

Background There is a controversy about the relationship of inflammatory factors with upper airway obstruction.Polysomnography serves as a "gold standard" in support of the diagnosis of obstructive sleep apnea syndrome(OSAS),it is not suitable for repeated monitoring due to complex operation,time-consuming and high cost.Objective To explore the relationship of red blood cell distribution width(RDW-CV) with polysomnography parameters and its influencing factors by retrospectively analyzing relevant data of hypertensive patients with OSAS.Methods Participants(n=287) were hypertensive patients discharged from Beijing Anzhen Hospital,Capital Medical University during 2017 to 2019 were collected at admission.High sensitivity C-reactive protein(hs-CRP),RDW-CV,oxygen desaturation index,lowest and mean oxygen saturation,apnea-hypopnea index(AHI),24 hSBP and 24 hDBP were detected during hospitalization.Those who were found with OSAS were stratified into mild,moderate and severe(number of apneas 5-15,16-30 and >30 times/h) subgroups by AHI level.Results At baseline,there were 62 patients without OSAS and 225 with OSAS,including 50 mild cases,78 moderate cases and 97 severe cases.Patients with OSAS had greater mean age,BMI,24 hSBP,RDW-CV and hs-CRP,as well as higher cardiovascular disease prevalence than those without(P<0.05).The RDW-CV value in patients with OSAS was positively correlated with age,BMI,24 hSBP,oxygen desaturation index,AHI and hs-CRP,and negatively correlated with the lowest and mean oxygen saturation(P<0.05).Multivariate Logistic regression analysis showed that age,AHI and hs-CRP were associated with RDW-CV(P<0.05).Conclusion RDW-CV may be related to polysomnography parameters in patients with hypertension and OSAS,indicating that it could be used as an easily monitored parameter.