阻塞性睡眠呼吸暂停与高血压患者血管损伤的相关性研究

Association between obstructive sleep apnea and vascular injury in hypertensive patients

目的探讨高血压患者中阻塞性睡眠呼吸暂停(OSA)、呼吸暂停低通气指数(AHI)与血管损伤的相关性。方法本研究为横断面研究,入选2020年4月至2023年4月于泰达国际心血管病医院高血压科住院且完成睡眠呼吸监测的高血压患者。收集入选患者的睡眠呼吸监测指标以及血流介导的血管扩张(FMD)、颈动脉内中膜厚度、颈-股脉搏波传导速度(cfPWV)、肱-踝脉搏波传导速度(baPWV)。根据AHI将OSA分为轻度(5次/h≤AHI<15次/h)、中度(15次/h≤AHI<30次/h)和重度(AHI≥30次/h)。将血管内皮损伤定义为FMD<6.0%,动脉僵硬度增加定义为cfPWV>10 m/s和(或)baPWV>18 m/s。应用多因素logistic回归分析探索AHI、OSA严重程度与血管损伤的相关性,并在青年(年龄≤45岁)及中老年(年龄>45岁)人群中进行亚组分析,通过排除合并糖尿病、脑血管疾病及冠心病的高血压患者进行敏感性分析。应用限制性立方样条分析AHI与血管功能指标的相关性。结果共纳入资料完善的成年高血压患者555例,年龄为(39.7±9.2)岁,男性422例(76.0%),OSA患病率为66.7%(370/555)。校正年龄、性别、体重指数、诊室平均动脉压等参数后,多因素logistic回归分析结果显示中度OSA(OR=2.83,P=0.019)及重度OSA(OR=3.40,P=0.016)与血管内皮损伤呈正相关。亚组分析结果显示,在青年高血压患者中可见log AHI(OR=1.99,P=0.035)及中(OR=4.83,P=0.010)、重度OSA(OR=4.64,P=0.015)与血管内皮损伤相关。敏感性分析结果与上述结果相似。限制性立方样条分析结果显示,AHI与FMD相关(P=0.022),且AHI介于0~10次/h时曲线斜率最大。多因素分析中均未见log AHI、OSA严重程度与颈动脉内中膜增厚、动脉僵硬度增加相关(P均<0.05)。结论高血压患者中合并OSA与血管内皮损伤相关,在青年高血压患者中更为明显,未见与颈动脉内中膜增厚、动脉僵硬度增加相关,结论尚需进一步研究验证。

ObjectiveTo investigate the relationship between obstructive sleep apnea(OSA),apnea hypopnea index(AHI)and vascular injury in hypertensive patients.MethodsThis cross-sectional study enrolled patients admitted to the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to April 2023,who finished portable sleep monitoring.Sleep monitoring indicators,flow-mediated vasodilation(FMD),carotid artery ultrasound,carotid intima-media thickness,cervical and femoral pulse wave conduction velocity(cfPWV),brachial and ankle pulse wave conduction velocity(baPWV)were analyzed.OSA was classified into mild(5 times/h≤AHI<15 times/h),moderate(15≤AHI<30 times/h),and severe(AHI≥30 times/h)based on AHI levels.FMD<6.0%was defined as vascular endothelial injury,and cfPWV>10 m/s and/or baPWV>18 m/s was defined as arterial stiffness.Multivariate logistic regression analysis was used to explore the correlation between AHI,OSA severity and vascular injury,and subgroup analysis was performed in young(age≤45 years)and middle-to-old patients(age>45 years).Sensitivity analysis was performed by excluding patients with diabetes,cerebrovascular disease and coronary heart disease.The correlation between AHI and vascular injury index was analyzed by restricted cubic spline.ResultsA total of 555 adult hypertensive patients were included,the mean age was(39.7±9.2)years,422 were males(76.0%),and the prevalence of OSA was 66.7%(370/555).Multivariate logistic regression analysis showed that moderate OSA(OR=2.83,P=0.019)and severe OSA(OR=3.40,P=0.016)were positively correlated with vascular endothelial injury after adjusting for age,sex,body mass index and mean arterial pressure.Subgroup analysis showed that log AHI(OR=1.99,P=0.035),moderate OSA(OR=4.83,P=0.010)and severe OSA(OR=4.64,P=0.015)were associated with vascular endothelial injury in young hypertensive patients.The results of sensitivity analysis were similar to the above results.The results of restricted cubic spline analysis showed that AHI was correlated with FMD(P=0.022),and the slope of the curve was the largest when AHI was between 0 and 10 times/h.There was no correlation between log AHI and OSA severity and carotid intima-media thickening and arterial stiffness(all P<0.05).ConclusionsOSA is associated with vascular endothelial injury in hypertensive patients,especially in young patients.