老年阻塞性睡眠呼吸暂停与代谢综合征各组分的相关性及其对远期不良心血管事件发生风险的影响

Correlation of obstructive sleep apnea with components of metabolic syndrome and implications for long‐term adverse cardiovascular risk in elderly patients

目的探讨老年阻塞性睡眠呼吸暂停(OSA)与代谢综合征(MetS)各组分的相关性及其对远期主要不良心血管事件(MACE)发生风险的影响。方法本研究为多中心前瞻性队列研究。2015年1月~2017年10月,多中心连续纳入1157例年龄≥60岁,基线无MACE病史且MetS指标完整的OSA患者作为随访队列,OSA由整夜多导睡眠监测记录的睡眠呼吸暂停低通气指数(AHI)≥5次/h定义。研究收集了所有患者的基线人口学数据、临床特征、生化指标、睡眠参数,按基线AHI的四分位水平分为4组,中位随访42个月,随访结局为MACE及其组成事件[心血管死亡、心肌梗死、需住院的心绞痛或心力衰竭]。采用多元线性回归和Cox比例风险回归模型分析MetS各组分与OSA的主要客观预判指标AHI和最低氧饱和度(LSpO2)的相关性及其远期的MACE发生风险。结果AHI和LSpO2四分位组均与MetS各组分[空腹血糖、腰围、收缩压、甘油三酯]存在正剂量效应关系,与高密度脂蛋白水平呈负剂量反应关系。中位42月随访期内,119例(10.3%)OSA患者发生了MACE。Cox回归分析结果显示,高甘油三酯、收缩压及腰围增加是MACE及其部分组成事件的独立危险因素(P<0.05,P<0.01),高高密度脂蛋白水平是MACE和心肌梗死的保护性因素(P<0.05,P<0.01),且独立于AHI;相比之下,独立于LSpO2的MetS各组分未表现出与MACE及其组成事件发生风险的相关性。结论老年OSA患者的主要诊断指标AHI和LSpO2与MetS各组分存在剂量效应关系,MetS中的部分组分与AHI相互作用可增加MACE及其组成事件的发生风险。

Objective To investigate the relationship between obstructive sleep apnea(OSA)and components of metabolic syndrome(MetS)in the elderly and the implications for long-term risk for major adverse cardiovascular events(MACE).Methods This multicenter prospective cohort study was conducted among 1157 consecutive patients with OSA[defined as an apnea-hypopnea index(AHI)≥5 times/h recorded by overnight polysomnography]aged≥60 years enrolled from January,2015 to October,2017.All the patients did not have a history of MACE at baseline and had complete documentations of MetS indicators.The baseline demographic data,clinical characteristics,biochemical markers,and sleep parameters were collected from all the patients,who were divided into 4 groups according to the quartile level of AHI and followed up for a median of 42 months for MACE and its component events(cardiovascular death,myocardial infarction,and hospitalization for unstable angina or heart failure).Multivariate linear regression and Cox proportional risk regression models were used to analyze the correlation of MetS components with major objective predictors of OSA,AHI and LSpO2 and the long-term risk of MACE.Results AHI and LSpO2 quartiles group showed a positive dose-response relationship with MetS components[fasting blood glucose,waist circumference,systolic blood pressure,and triglycerides]and a negative dose-response relationship with high-density lipoprotein level.MACE occurred in 119(10.3%)patients with OSA during the follow-up.Multivariate Cox regression analysis showed that a high triglycerides,a high systolic blood pressure,and an increased waist circumference were independent risk factors for MACE and its component events(P<0.05 or 0.01);a high HDL was a protective factor against MACE and myocardial infarction(P<0.05 or 0.01)independent of the AHI.MetS components independent of LSpO2 showed no significant correlations with the risk of MACE or its component events.Conclusion The major diagnostic indexes AHI and LSPO2 in elderly patients with OSA have a dose-response relationship with MetS components,and the interaction between the components of MetS and AHI can increase the risk of MACE and its component events.