合并OSAHS及严重程度对稳定期COPD患者左心功能及心血管事件发生风险的影响

Influence of Complicated with OSAHS and OSAHS Severity on Left Heart Function and Risk of Cardiovascular Events in COPD Patients with Stable Stage

目的探讨合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)及严重程度对稳定期慢性阻塞性肺疾病(COPD)患者左心舒张功能及心血管事件发生风险的影响。方法纳入2018年1月—2022年1月内蒙古自治区人民医院诊治稳定期COPD患者共272例,根据是否合并OSAHS分为合并组(200例)和未合并组(72例),同时根据合并OSAHS严重程度分为轻度组(123例)、中度组(45例)及重度组(32例);分析一般资料、心肺功能指标及预后指标;采用多元线性回归模型评价AHI与相关临床指标间的独立关系。结果合并组夜间平均血氧饱和度和最低血氧饱和度显著低于未合并组,差异有统计学意义(P<0.05);合并组氧减指数、血氧饱和度≤90%时间占比及LVMI均显著高于未合并组,差异有统计学意义(P<0.05);合并组OSAHS严重程度亚组之间E/e′、LAD、冠心病及充血性心力衰竭发生率比较,差异有统计学意义(P<0.05);多元线性回归分析结果显示,在未校正任何因素、校正年龄和身体质量指数及校正年龄、性别、身体质量指数、充血性心力衰竭史、冠心病史、高血压史、肺心病史及吸烟情况三个模型中,以E/e′为因变量,AHI为自变量,合并OSAHS患者E/e′均随AHI水平增加而升高,差异有统计学意义(P<0.05)。结论稳定期COPD患者如合并OSAHS则左心功能损伤更为明显,心血管事件发生风险亦更高;同时OSAHS严重程度与左心功能损伤具有相关性。

Objective To investigate the influence of complicated with OSAHS and OSAHS severity on left heart function and risk of cardiovascular events in COPD patients with stable stage.Methods 272 COPD patients with stable stage were retrospectively chosen in the period from January 2018 to January 2022 in our hospital.All patients were divided into the combined group(200 cases)and non-combined group(72 cases)according to combined with OSAHS or not,and mild group(123 cases),moderate group(45 cases)and severe group(32 cases)according to OSAHS severity.The general data,cardiopulmonary function indexes and prognostic indexes were analyzed.Multiple linear regression model was used to evaluate the independent relationship between AHI and related clinical indicators.Results The mean and minimum blood oxygen saturation at night in combined group were significantly lower than non-combined group(P<0.05).The oxygen desaturation index,time proportion of blood oxygen saturation≤90%and LVMI in combined group were significantly higher than those in non-combined group(P<0.05).There were statistically significant diff erences in the incidence of E/e',LAD,incidence of coronary heart disease and congestive heart failure among OSAHS severity subgroups(P<0.05).Multiple linear regression analysis showed that E/E'was the dependent variable and AHI was the independent variable in the three models without adjusting for any factor,adjusted for age and BMI adjusted for age,sex,BMI,congestive heart failure history,history of coronary heart disease,history of hypertension,history of pulmonary heart disease and smoking status.E/e'of patients with OSAHS higher with the increased of AHI level(P<0.05).Conclusion The left heart function damage was more obvious and the risk of cardiovascular events was higher in stable stage COPD patients complicated with OSAHS and the severity of OSAHS was correlated with left heart function injury.