老年代谢综合征合并睡眠呼吸暂停低通气综合征患者临床特征研究

Clinical characteristics of elderly patients with metabolic syndrome and obstructive sleep apnea hypoventilation syndrome

目的探讨老年代谢综合征(Metabolic syndrome,MS)合并睡眠呼吸暂停低通气综合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)患者临床特征。方法选择2015年1月—2021年6月于广西河池市人民医院内分泌科收治住院的老年MS患者120例为研究对象,均使用便携式睡眠呼吸监测仪进行睡眠呼吸情况筛查,根据患者是否合并OSAHS分为单纯MS组(n=32)和MS合并OSAHS组(n=88),并根据每小时睡眠发生呼吸暂停和低通气次数之和(AHI)将MS合并OSAHS组患者分为轻度组(n=32)、中度组(n=29)、重度组(n=27)3个亚组。统计所有患者一般资料,分析老年MS合并OSAHS患者临床特征及影响因素。结果120例老年MS患者中,有88例合并OSAHS,总发生率为73.33%(88/120),以轻度OSAHS占比最高,为36.36%(32/88)。MS各组分间以腹型或中心型肥胖组OSAHS发病率最高。相比于单纯MS组,MS合并OSAHS组有吸烟史(28.41%)、有合并症/并发症(77.27%)占比较高,体质量指数(BMI)、腰围、血压升高,血糖、血脂紊乱,胰岛素分泌增多,C-反应蛋白(CRP)、同型半胱氨酸(Hcy)、AHI升高,夜间最低脉氧饱和度(LSPO_(2))、平均脉氧饱和度(MSPO_(2))降低(P<0.05)。Logistic回归分析显示,BMI、高血压、收缩压、舒张压、FBG、TG、HDL-C、CRP、Hcy导致老年MS患者并发OSAHS的独立危险因素(P<0.05)。随着老年MS合并OSAHS患者病情的加重,BMI、腰围、收缩压、舒张压、HbA_(1)C、FBG、TG、CHO、FINS、HOMA-IR、CRP、Hcy、AHI逐渐升高,HDL-C、LSPO_(2)、MSPO_(2)逐渐降低(P<0.05)。Logistic回归显示,高血压、BMI、FBG、TG、CRP、Hcy、LSPO_(2)、MSPO_(2)为影响老年MS合并OSAHS患者病情程度独立危险因素(P<0.05)。结论老年MS患者存在较高的OSAHS并存率,与老年MS患者相比较,老年MS合并OSAHS患者临床特征表现为糖脂代谢紊乱,伴随更高的BMI、血压、CRP、Hcy。

Objective To investigate the clinical characteristics of elderly patients with metabolic syndrome(MS)and obstructive sleep apnea hypoventilation syndrome(OSAHS).Methods 120 elderly patients with MS admitted to Department of Endocrinology of People’s Hospital of Hechi City from January 2015 to June 2021 were selected as the research subjects.A portable sleep breathing monitor was used to screen the sleep breathing of patients.They were divided into simple MS group(n=32)and MS combined with OSAHS group(n=88)according to whether they had OSAHS.According to the sum of apnea and hypopnea times per hour of sleep(AHI),the patients in MS combined with OSAHS group were divided into three subgroups:mild group(n=32),moderate group(n=29)and severe group(n=27).The general data of all patients were collected,and the clinical characteristics and influencing factors of elderly MS patients with OSAHS were analyzed.Results Among 120 elderly MS patients,88 ones were complicated with OSAHS,the total incidence was 73.33%(88/120),and mild OSAHS accounted for the highest proportion[36.36%(32/88)].Among all types of MS groups,the incidence of OSAHS was highest in abdominal or central obesity group.The proportion of smoking history(28.41%)and comorbidities/complications(77.27%)in the MS combined with OSAHS group was higher than that in the simple MS group;the body mass index(BMI),waist circumference and blood pressure were higher than those in the simple MS group;the ratio of blood glucose and lipid disorders,increased insulin secretion,and the levels of C-reactive protein(CRP),homocysteine(Hcy)and AHI in the MS combined with OSAHS group were higher than those in the simple MS group,and the minimal pulse oxygen saturation(LSPO_(2))and mean pulse oxygen saturation(MSPO_(2))at night were lower than those in the simple MS group(P<0.05).Logistic regression analysis showed that BMI,hypertension,systolic blood pressure,diastolic blood pressure,FBG,TG,HDL-C,CRP,Hcy were independent risk factors of OSAHS in elderly MS patients(P<0.05).With the aggravation of the elderly MS patients with OSAHS,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,HbA_(1 c),FBG,TG,CHO,FINS,HOMA-IR,CRP,Hcy,AHI increased gradually,and HDL-C,LSPO_(2),MSPO_(2)decreased gradually(P<0.05).Logistic regression showed that hypertension,BMI,FBG,TG,CRP,Hcy,LSPO_(2),MSPO_(2)were independent risk factors affecting the severity of the elderly MS patients with OSAHS(P<0.05).Conclusion There is a high co-occurrence rate of OSAHS in elderly MS patients.Compared with elderly MS patients,the clinical characteristics of elderly MS patients with OSAHS are glucose and lipid metabolism disorder,accompanied by higher BMI,blood pressure,CRP,Hcy.