持续正压通气对老年中重度阻塞性睡眠呼吸暂停并脑梗死患者血压变异及预后影响

Effect of CPAP ventilation on BPV and outcomes in elderly moderate-severe OSAS patients with cerebral infarction

目的 探讨持续气道正压通气(CPAP)对老年阻塞性睡眠呼吸暂停综合征(OSAS)并脑梗死患者短中期血压变异性(BPV)及预后的影响。方法 前瞻性纳入2018年3月~2021年3月郑州人民医院神经内科住院的老年OSAS并脑梗死患者158例,按随机数字表法分为治疗组52例和对照组106例,比较2组入院时、出院时、6个月BPV指标[收缩压的标准差(SD)、变异系数(CV)]、神经功能指标[美国国立卫生研究院卒中量表(NIHSS)和斯堪的那维亚卒中量表(SSS)评分],记录随访时脑梗死再发情况。OSAS严重程度根据呼吸暂停低通气指数(AHI)分为轻度、中度和重度,比较不同程度OSAS预后差异。用二元logistic回归分析BPV的影响因素。结果 二元logistic回归模型未调整或校正混杂因素分析示,AHI为BPV升高的危险因素(OR=3.317,95%CI:2.032~5.412,P=0.000,OR=7.473,95%CI:1.455~38.376,P=0.016)。治疗组出院时和6个月CV、SD、NIHSS评分均较对照组降低,SSS评分较对照组升高(P<0.05)。治疗组脑卒中再发比例较对照组降低(5.77%vs 17.92%,P=0.038)。治疗组中度和重度OSAS患者出院时和6个月NIHSS评分较对照组降低;SSS评分较对照组升高(P<0.05,P<0.01)。结论 CPAP治疗能够降低老年OSAS并脑梗死患者BPV,改善中重度OSAS患者早中期预后。

Objective To study the effect of continuous positive airway pressure(CPAP) on short-and middle-term blood pressure variability(BPV) and outcomes in elderly obstructive sleep apnea syndrome(OSAS) patients with cerebral infarction.Methods One hundred and fifty-eight OSAS patients with cerebral infarction admitted to our hospital from March 2018 to March 2021 were randommly divided into CPAP treatment group(CPAP treatment, n=52) and control group(non-CPAP treatment, n=106).The BPV parameters(SBP SD and CV),neurological parameters(NIHSS score and SSS score) on admission, at discharge and during the 6-month follow-up period were compared between the two groups.The recurrence of cerebral infarction was recorded during the 6-month follow-up period.The OSAS was divied into mild OSAS,moderate OSAS and severe OSAS according to the AHI.The outcomes were compared between the two groups.The risk factors for BPV in elderly OSAS patients with cerebral infarction were analyzed by binary logistic regression analysis.Results Binary logistic regression analysis showed that AHI was a risk factor for BPV in elderly OSAS patients with cerebral infarction whether the confounding factors were adjusted or not adjusted(OR=3.317,95%CI:2.032-5.412,P=0.000;OR=7.473,95%CI:1.455-38.376,P=0.016).The CV,SD and NIHSS score were significantly lower while the SSS score was significantly higher in CPAP treatment group than in control group on admission and during the 6-month follow-up period(P<0.05).The recurrence rate of stroke was significantly lower in CPAP treatment group than in control group during the 6-month follow-up period(5.77% vs 17.92%,P=0.038).The SSS score was signifycantly higher in CPAP treatment group than in control group(P<0.01).Conclusion CPAP treatment can reduce the BPV and improve the short-and middle-term outcomes in elderly OSAS patients with cerebral infarction.