多囊卵巢综合征合并阻塞性睡眠呼吸暂停临床特征与危险因素分析

Clinical features and risk factors of polycystic ovary syndrome complicated with obstructive sleep apnea

目的探讨多囊卵巢综合征(PCOS)合并阻塞性睡眠呼吸暂停(OSA)的危险因素、临床特点以及激素水平变化。方法纳入确诊PCOS患者74名,根据呼吸暂停低通气指数,分为单纯PCOS组和合并OSA组,后者又分为合并轻度和中重度OSA组;根据体质量指数将PCOS患者分为超重组和常重组。比较各组临床特点以及激素水平。结果33.78%PCOS患者合并OSA,其中10.81%合并中重度OSA。与单纯PCOS相比,合并OSA的PCOS患者腰臀比更大,性激素类使用率、雌激素以及抗Müllerian激素水平更低(P<0.05);合并中重度OSA患者的空腹血糖和低密度脂蛋白水平更高,年龄更大,体质量指数、腰围更高。回归分析结果显示,高腰臀比是PCOS合并OSA的危险因素,使用性激素类及高水平抗Müllerian激素是保护因素。其中,抗Müllerian激素水平高者合并OSA的风险更低(OR=0.847,95%CI 0.725~0.988,P=0.035);ROC曲线下面积0.703,灵敏度0.878,特异度0.500,界值为4.330 ng/mL;高于此界值者的风险更低(OR=0.140,95%CI 0.043~0.450,P=0.001)。结论PCOS患者OSA患病率较高,高水平抗Müllerian激素具有保护作用。

Objective To investigate the risk factors,clinical features and hormone levels of polycystic ovary syndrome(PCOS)complicated with obstructive sleep apnea(OSA).Methods A total of 74 patients with confirmed PCOS were enrolled.According to the apnea-hypopnea index,they were divided into the simple PCOS group and the complicated OSA group.The latter was further divided into the mild group and the moderate and severe group.According to the body mass index,PCOS patients were divided into the over-weight group and the normal-weight group.Their clinical characteristics and hormone levels were compared.Results 33.78% of PCOS patients had OSA,of which 10.81%had moderate to severe OSA.Compared with the simple PCOS group,the complicated OSA group had a higher waist-to-hip ratio,and lower levels of sex hormones,estrogen and anti-Müllerian hormones(P<0.05).Those moderate to severe OSA patients with higher fasting blood glucose and low-density lipoprotein levels were older and had higher body mass index and waist circumference.Regression analysis results showed that high waist-to-hip ratio was a risk factor for PCOS complicated with OSA,and the use of sex hormones and high levels of anti-Müllerian hormones were protective factors.Among them,those with high levels of anti-Müllerian hormones had a lower risk of complicated with OSA(OR=0.847,95%CI 0.725~0.988,P=0.035).The area under the ROC curve was 0.703,the sensitivity was 0.878,the specificity was 0.500,and the cutoff value was 4.330 ng/mL.The risk was lower when the level was higher than this threshold(OR=0.140,95%CI 0.043~0.450,P=0.001).Conclusion The prevalence of OSA in PCOS patients is relatively higher,and the high levels of anti-müllerian hormones have a protective effect.