阻塞性睡眠呼吸暂停综合征与脑白质病变相关性的研究

Study on correlation between obstructive sleep apnea syndrome and white matter lesions

目的阻塞性睡眠呼吸暂停综合征(between obstructive sleep apnea syndrome,OSAS)与高血压和心脑血管疾病相关,OSAS期间的短暂缺氧,高碳酸血症和血压升高是脑白质病变(white matter lesions,WMC)的危险因素。本研究旨在探讨OSAS与WMC之间的相关性。方法2017年2月—2021年12月郑州市第三人民医院神经内科100例同时具有多导睡眠图和脑磁共振(MRI)检查患者的临床资料,根据睡眠呼吸暂停低通气指数(AHI)分为非OSAS组21例、轻度OSAS组39例、中重度OSAS组40例,并根据脑MRI及Fazekas评分量表对所有患者进行脑白质病变评分,分析不同OSAS严重程度分组脑白质病变情况,并行二元logstic回归分析确定WMC的独立危险因素。结果不同OSAS严重程度分组之间WMC病变程度的分布具有显著差异(P=0.007),中重度OSAS组较非OSAS组及轻度OSAS组WMC病变程度分布差异均具有统计学差异,P值分别为0.001和0.034;WMC的患病率随OSAS严重程度增加而增加;AHI与WMC患病风险升高均有关(OR=1.082,95%CI:1.035~1.131,P<0.001),除了AHI以外,方程中有意义的变量还有年龄(OR=1.107,95%CI:1.107=1.036,P=0.003)、是否患有高血压(OR=1.223,95%CI:1.013~1.476,P=0.036)。结论在OSAS中,尤其是在中重度OSAS中,WMC病变的发生率增加,AHI、年龄、高血压病是影响WMC病变的独立危险因素。

Objective Obstructive sleep apnea syndrome(OSAS) is associated with systemic hypertension and cardiovascular and cerebrovascular diseases,transient hypoxia during OSAS,hypercapnia and elevated blood pressure are the risk of white matter lesions(WMC) factor.This study aims to explore the correlation between OSAS and WMC.Methods The clinical data of 100 patients with both polysomnography and cranial MRI examination were collected.According to sleep apnea hypopnea index(AHI),they were divided into 21 cases in non-OSAS group,39 cases in mild OSAS group,and 40 cases in moderate to severe OSAS group.For example,according to the head MRI and Fazekas score scale,all patients were scored for white matter lesions,and the conditions of the white matter lesions were analyzed by different OSAS severity groups.Parallel binary logistic regression analysis was used to determine the independent risk factors of WMC.Results There were significant differences in the distribution of WMC lesions between different OSAS severity groups(P=0.007).The difference in the distribution of WMC lesions between the moderate and severe OSAS group was statistically different than that in the non-OSAS group and the mild OSAS group.The P values were 0.001 and 0.034;The prevalence of WMC increases with the severity of OSAS;AHI was associated with an increased risk of WMC(OR= 1.082,95% CI:1.035-1.131,P<0.001),except for AHI,the significant variables in the equation were age(OR= 1.107,95% CI:1.107 = 1.036,P=0.003),and whether they have hypertension(OR= 1.223,95% CI:1.013-1.476,P=0.036).Conclusion In OSAS,especially in moderate to severe OSAS,the incidence of WMC lesions increases.AHI,age,and hypertension are independent risk factors that affect WMC lesions.