阻塞性睡眠呼吸暂停患者颈动脉内膜中层厚度进展的相关因素分析

Analysis of factors related to the progression of carotid intima-media thickness in patients with obstructive sleep apnea

目的探讨阻塞性睡眠呼吸暂停(Obstructive sleep apnea,OSA)患者颈动脉内膜中层厚度(intima-media thickness,IMT)进展的相关因素。方法选取我院在2015年1月至8月期间新诊断为OSA患者93例。分别在2015年和2018年对患者的IMT进行了测量。采用多变量回归模型确定IMT进展的预测指标。结果随着随访时间的延长,OSA患者的颈动脉IMT、呼吸暂停低通气指数(AHI)、BMI、高密度脂蛋白胆固醇、总胆固醇和同型半胱氨酸水平升高,颈动脉壁增厚或斑块、高血压、中度OSA和糖尿病比例升高(P<0.05)。在基线和随访结束时的AHI均与横截面测量的IMT及其进展独立相关(P<0.05)。基线AHI及其3年(2015-2018年)内的变化与动脉斑块存在风险和高IMT风险独立相关(P<0.05)。将研究人群分组后观察到IMT进展与HR和AHI变化呈线性关系(P=0.014、0.008)。结论AHI、HR参与IMT的进展,AHI与动脉斑块存在独立风险关系。

Objective To explore the factors related to the development of carotid intima-media thickness(IMT)in patients with obstructive sleep apnea(OSA).Methods A total of 93 patients with OSA newly diagnosed in our hospital from January to August 2015 were selected.Patients′IMT was measured in 2015 and 2018,respectively.Predictors of IMT progression were determined using multivariate regression models.Results With longer follow-up,OSA patients had higher IMT,apnea-hypopnea index(AHI),BMI,high-density lipoprotein cholesterol,total cholesterol,and homocysteine levels,and a higher proportion of carotid wall thickening or plaque,hypertension,moderate OSA,and diabetes(P<0.05).The AHI at baseline and the end of follow-up were independently correlated with cross-sectionally measured IMT and its progression(P<0.05).The baseline AHI and its changes in 3 years(2015-2018)were independently associated with the risk of arterial plaque presence and high IMT risk(P<0.05).A linear relationship between IMT progress and changes in HR and AHI was observed after subgrouping the population(P=0.014,0.008).Conclusions AHI and HR are always involved in the progression of IMT,and there is an independent risk relationship between AHI and arterial plaque.