睡眠重叠综合征患者发生肺动脉高压的风险研究

Factors associated with pulmonary hypertension in patients with concomitant obstructive ventilatory defect and sleep apnea:the overlap syndrome

目的:探分析同时罹患阻塞性睡眠呼吸暂停(OSA)和阻塞性通气障碍(OVD)的睡眠重叠综合征(OS)患者,发生肺动脉高压(PH)的风险及危险因素。方法:收集2019年1月至2019年12月,在首都医科大学附属北京安贞医院呼吸与危重症医学科接受呼吸睡眠监测和肺功能检查的204例患者。同时符合OSA和OVD诊断标准的患者被诊断OS。分别以超声心动图测得肺动脉收缩压(SPAP)>50mmHg(1mmHg=0.133kPa)和35mmHg作为PH确诊和疑诊的标准。使用多元Logistic回归模型分析PH发病的相关因素。结果:与单纯OSA和单纯OVD组相比,OS患者睡眠平均血氧饱和度(MeanSaO_(2))(92%vs.93%vs.95%,P<0.05)显著偏低。OS患者发生PH概率较单纯OSA组偏高(SPAP≥50mmHg,OR=2.66,95%CI:1.13~6.82,P=0.024;SPAP≥35mmHg,OR=2.43,95%CI:1.22~5.02,P=0.012)。在校正了年龄、性别和BMI后,OS患者发生PH概率分别较单纯OSA和OVD组升高(SPAP≥50mmHg,OR=3.17,95%CI:1.22~8.94,P=0.017和OR=3.88,95%CI:1.25~14.52,P=0.018;SPAP≥35mmHg,OR=2.41,95%CI:1.14~5.22,P=0.02和OR=2.25,95%CI:0.92~5.86,P=0.07)。MeanSaO_(2)低于93%的患者疑诊PH的风险是其对照人群的3.15倍(SPAP≥35mmHg,OR=3.15,95%CI0.98~10.11,P=0.049)。结论:OS患者发生PH的概率显著增加,其中夜间睡眠低氧血症可能是导致OS患者发生PH的独立相关因素。

Objective:To analysis risk factors of pulmonary hypertension(PH)in patients with sleep overlap syndrome(OS)of obstructive sleep apnea(OSA)and obstructive ventilatory disorder(OVD).Methods:204 patients were recruited in the Department of Pulmonary and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University from January 2019 to December 2019.Sleep test and spirometry were used to identify OSA and OVD.OS was diagnosed when patients were met both criteria of OSA and OVD.The diagnosis and suspicion of PH were measured from echocardiography by the systolic pulmonary arterial pressure(SPAP)greater than 50 mmHg and 35 mmHg respectively.Independent correlative factors for the prevalence of PH were analyzed by multiple logistic regression model.Results:Compared with subjects with isolated OSA and OVD,patients with OS had lower average nocturnal saturation(MeanSaO_(2))(92%vs.93%and 95%,P<0.05).Patients with OS had higher odds of PH compared to isolated OSA group(SPAP≥50mmHg,OR=2.66,95%CI:1.13-6.82,P=0.024;SPAP≥35mmHg,OR=2.43,95%CI:1.22-5.02,P=0.012).After adjusting of confounding variables for age,gender and BMI patients with OS still had higher odds of PH compared to isolated OSA and isolated OVD group respectively(SPAP≥50mmHg,OR=3.17,95%CI:1.22-8.94,P=0.017 and OR=3.88,95%CI:1.25-14.52,P=0.018;SPAP≥35mmHg,OR=2.41,95%CI:1.14-5.22,P=0.02 and OR=2.25,95%CI:0.92-5.86,P=0.07).The patients with MeanSaO_(2)<93%vs MeanSaO_(2)≥93%had significantly higher odds of being diagnosed with suspected PH(SPAP≥35mmHg,OR=3.15,95%CI:0.98-10.11,P=0.049).Conclusions:Patients with OS of OSA and OVD suffered from nocturnal sleep hypoxemia which is associated with the prevalence of PH.