阻塞性睡眠呼吸暂停对急性冠脉综合征患者血脂水平的影响

Effects of obstructive sleep apnea on lipid levels in patients with acute coronary syndrome

目的探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)对急性冠脉综合征(acute coronary syndrome,ACS)患者血脂水平的影响。方法本项研究基于一项单中心、前瞻性队列研究(OSA-ACS)。选取2015年6月至2020年1月于首都医科大学附属北京安贞医院住院的ACS患者,对所有入选患者行便携式睡眠呼吸监测仪检查。根据睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为中/重度OSA组(AHI≥15次/h)和无/轻度OSA组(AHI<15次/h),比较两组患者的临床特点、睡眠监测数据和血脂相关指标[甘油三酯(triglyceride,TG)、总胆固醇(total cho-lesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、残余脂蛋白胆固醇(residual cholesterol,RC)、甘油三酯/高密度脂蛋白胆固醇(TG/HDL-C)、总胆固醇/高密度脂蛋白胆固醇(TC/HDL-C)、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇(LDL-C/HDL-C)]等。采用Pearson相关性分析计算AHI与HDL-C水平的关系。采用二元Logistic回归模型分析ACS患者影响HDL-C的危险因素。结果本研究共纳入1927例ACS患者,其中1014例(52.6%)患者合并中/重度OSA。中/重度OSA患者的HDL-C水平显著低于无/轻度OSA患者(P=0.002),两组的其他血脂指标差异均无统计学意义(P>0.05)。Pearson相关性分析显示HDL-C水平与AHI呈弱负相关(r=-0.078,P=0.001)。校正年龄、性别、肥胖、高血压、糖尿病、ACS类型、左室射血分数、吸烟和饮酒等因素,二元Logistic回归分析显示,中/重度OSA是ACS患者HDL-C降低的独立危险因素(β=0.225,OR=1.253,95%CI:1.010~1.554,P=0.040)。结论在ACS患者中,中度/重度OSA是HDL-C水平降低的独立危险因素,且不受性别、肥胖、高血压、糖尿病等其他危险因素影响。

Objective To investigate the effect of obstructive sleep apnea(OSA)on lipid levels in patients with acute coronary syndrome(ACS).Methods This study was based on a large,single-center,prospective cohort study(OSA-ACS).From June 2015 to January 2020,ACS patients who hospitalized at Beijing Anzhen Hospital,Capital Medical University were undertaken portable sleep monitor.Patients were divided into moderate/severe OSA group[apnea-hypopnea index(AHI)≥15 events/hour]and no/mild OSA group(AHI<15 events/hour).The general clinical data,sleeping monitor data and lipid parameters[triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),non-HDL-C,residual cholesterol(RC),TG/HDL-C,TC/HDL-C,LDL-C/HDL-C]in two groups were compared.Pearson correlation analyses were used to calculate the effects of AHI on HDL-C level.Multivariate Logistic regression analyses were performed to determine the independent risk factors of HDL-C level in patients with ACS.Results A total of 1927 ACS patients were enrolled,including 1014(52.6%)patients in moderate/severe OSA group.Compared with no/mild OSA group,HDL-C level was significantly higher in moderate/severe OSA group(P=0.002).No differences were observed between the other lipid profiles in the two groups(all P>0.05).Pearson correlation analysis showed that HDL-C level was weakly negatively correlated with AHI(r=-0.078,P=0.001).After adjusting for age,gender,obesity,hypertension,diabetes,ACS types,left ventricular ejection fraction,smoking and alcohol consumption,Logistic regression analysis showed that moderate/severe OSA was an independent risk factor for HDL-C reduction in patients with ACS(β=0.225,OR=1.253,95%CI:1.010~1.554,P=0.040).Conclusions In patients with ACS,moderate/severe OSA may be an independent risk factor for decreased HDL-C levels,regardless of sex,obesity,hypertension,diabetes,smoking,and other risk factors.