总睡眠时间和氧减指数与OSA合并高血压的关联分析

Association of total sleep time and oxygen desaturation index with hypertension in patients with obstructive sleep apnea/hypopnea syndrome

目的:探讨总睡眠时间(TST)和氧减指数(ODI)与阻塞性睡眠呼吸暂停(OSA)合并高血压的关联。方法:该研究为横断面研究。连续纳入2017年1月1日至2022年12月31日江苏大学附属宜兴医院收治的OSA患者,根据是否合并高血压分为OSA+高血压组和OSA组。通过电子病历系统收集患者的一般临床资料和多导睡眠监测的相关指标[TST、ODI、呼吸暂停低通气指数(AHI)、血氧饱和度<90%的时间占总睡眠时间的百分比(T90%)、最低血氧饱和度(LSaO 2)、平均血氧饱和度(MSaO 2)等]。采用logistic回归模型分析OSA合并高血压的关联因素。在多因素logistic回归模型中引入相乘项并逐步调整混杂因素分析TST与ODI对OSA合并高血压的相乘交互作用,对TST和ODI进行两因素叉生分析,并通过相加交互作用模型分析TST与ODI对OSA合并高血压的相加交互作用。结果:纳入患者440例,年龄(51.8±12.7)岁,男性363例(82.50%),其中合并高血压者236例(OSA+高血压组),未合并高血压者204例(OSA组)。单因素logistic回归分析结果显示,男性、吸烟、合并糖尿病、合并冠心病、TST<7 h以及年龄、体重指数、颈围、腰围、Epworth嗜睡量表(ESS)评分、TST、AHI、ODI>16次/h、甘油三酯、高密度脂蛋白胆固醇、空腹血糖增加与OSA合并高血压存在正向关联(均P<0.05)。多因素logistic回归分析结果显示,吸烟(OR=4.327,95%CI:2.499~7.489,P=0.023,P<0.001)、TST<7 h(OR=1.748,95%CI:1.079~2.832,P=0.023)和ODI>16次/h(OR=3.482,95%CI:2.016~6.014,P<0.001)与OSA合并高血压存在独立正向关联。引入相乘项并逐步调整混杂因素,结果显示TST<7 h与ODI>16次/h存在正向相乘交互作用(OR=2.958,95%CI:1.079~8.113,P<0.05)。多因素logistic回归分析结果显示TST<7 h且ODI>16次/h的OSA患者合并高血压的风险是TST≥7 h且ODI≤16次/h者的7.196倍(95%CI:3.421~15.137)。相加交互作用模型分析结果显示TST<7 h与ODI>16次/h存在正向相加交互作用,S值为4.302(95%CI:1.566~11.815),RERI值为4.756(95%CI:0.642~8.869),API值为66.10%(95%CI:43.10%~89.10%)。结论:TST缩短和ODI升高均与OSA合并高血压存在独立关联,且二者存在交互作用,二者并存时可能会进一步增加OSA合并高血压的风险。

Objective To investigate the association of total sleep time(TST)and oxygen desaturation index(ODI)with hypertension in patients with obstructive sleep apnea/hypopnea syndrome(OSA).Methods A total of 440 OSA patients admitted to Yixing Hospital from January 2017 to December 2022 were consecutively enrolled,including 236 patients with hypertension(OSA+hypertension group)and 204 patients without hypertension(OSA group).The clinical data and polysomnograpic parameters were collected.Univariate and multivariate logistic regression was used to analyze the related factors of OSA complicated with hypertension.The multiplicative interaction between TST and ODI on OSA with hypertension was analyzed.A two-factor cross-over analysis of TST and ODI was performed and the additive interaction model was used to analyze the additive interaction between TST and ODI on OSA with hypertension.Results Univariate logistic regression showed that male sex,smoking,diabetes,coronary heart disease,TST<7 h,age,body mass index,neck circumference,waist circumference,Epworth Sleepiness Scale(ESS)score,TST,AHI,ODI>16 times/h,triglyceride,high density lipoprotein cholesterol and fasting blood glucose were positively correlated with hypertension in OSA patients(all P<0.05).Multivariate logistic regression analysis showed that smoking(OR=4.327,95%CI:2.499-2.499,P<0.001),TST<7 h(OR=1.748,95%CI:1.079-2.832,P=0.023)and ODI>16 times/h(OR=3.482,95%CI:2.016-6.014,P<0.001)were independently associated with hypertension in OSA patients.After introducing a multiplicative term and adjusting for confounding factors,there was a positive multiplication interaction between TST<7 h and ODI>16 times/h(OR=2.958,95%CI:1.079-8.113,P<0.050).Multivariate logistic regression analysis showed that the risk of hypertension in OSA patients with TST<7 h and ODI>16 times/h was 7.196 times(95%CI:3.421-15.137)higher than that in patients with TST≥7 h and ODI≤16 times/h.The additive interaction model showed a synergistic effect between TST<7 h and ODI>16 times/h,with S value of 4.302(95%CI:1.566-11.815),RERI value of 4.756(95%CI:0.642-8.869)and API value of 66.10%(95%CI:43.10%-89.10%).Conclusion Shortened sleep duration and increased ODI are independent risk factors for hypertension in OSA patients,and when they coexist,the risk of hypertension in OSA patients is further increased.