急性缺血性脑卒中伴OSAHS患者中医证型与睡眠监测指标的相关性分析

Correlation analysis between traditional Chinese medicine syndromes and sleep monitoring indexes in acute ischemic stroke patients with OSAHS

目的探讨急性缺血性脑卒中(AIS)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中医证型与睡眠监测指标的相关性。方法根据睡眠呼吸监测结果将145例AIS患者分为伴OSAHS组(81例)、不伴OSAHS组(64例),比较两组性别、年龄、体质量指数(BMI)、颈围、胸围、腰围、美国国立卫生研究院卒中量表(NIHSS)评分的差异;收集中医证候信息,并进行中医辨证分型,比较不同严重程度、不同中医证型AIS患者的呼吸暂停低通气指数(AHI)和最低末梢指脉氧(LSpO2)水平;采用二元logistics回归分析法分析中医证型与睡眠监测指标的相关性。结果①两组BMI、胸围、腰围差异有统计学意义(P<0.05)。②伴OSAHS组以风痰瘀阻证多见(43.2%),不伴OSAHS组以风火上扰证多见(31.3%);两组中医证型分布情况比较,差异有统计学意义(P<0.05)。③伴OSAHS组患者的NIHSS评分高于不伴OSAHS组(P<0.05)。④145例AIS患者中,轻型90例、非轻型55例。轻型AIS患者LSpO2值高于非轻型AIS患者(P<0.05);两组AHI值比较,差异无统计学意义(P>0.05)。⑤不同证型AIS患者AHI、LSpO2值差异有统计学意义(H=27.614,P<0.05;H=20.939,P<0.05)。进一步两两比较,风痰瘀阻证患者AHI值最高、LSpO2值最低(P<0.05)。⑥二元logistic回归分析显示,OSAHS病情严重程度[OR=0.635,95%CI(0.419~0.962),P<0.05]是预测风火上扰证的独立影响因素,性别[OR=3.986,95%CI(1.178~13.488),P<0.05]、AHI[OR=1.090,95%CI(1.046~1.136),P<0.05]、OSAHS病情严重程度[OR=3.162,95%CI(2.073~4.824),P<0.05]是预测风痰瘀阻证的独立影响因素,性别[OR=0.225,95%CI(0.060~0.850),P<0.05]、BMI[OR=1.170,95%CI(1.025~1.335),P<0.05]是预测气虚血瘀证的独立影响因素,AHI[OR=0.907,95%CI(0.826~0.996),P<0.05]是预测阴虚风动证的独立影响因素。结论AIS伴OSAHS患者中风痰瘀阻证最为常见,此类患者AHI更高,夜间低血氧程度更重;性别、BMI、AHI、OSAHS病情严重程度与AIS伴OSAHS患者的中医辨证分型具有一定的相关性,可为本病的中医辨证论治提供一定参考。

Objective To explore the correlation between traditional Chinese medicine(TCM)syndromes and sleep monitoring indexes in patients Methods results,145 AIS patients were divided into two groups:those with OSAHS(n=81)and those without OSAHS(n=64).We compared differences in gender,age,body mass index(BMI),neck,chest,and waist circumferences,and national institutes of health stroke scale(NIHSS)scores.TCM syndromes were documented and analyzed through TCM syndrome differentiation.Apnea-hypopnea index(AHI)and lowest oxygen saturation(LSpO2)values were compared across different severities and TCM syndromes.Binary logistic regression was used to assess the correlation between TCM syndromes and sleep monitoring indexes.Results①There were statistically significant differences in BMI,chest,and waist circumferences between the two groups(P<0.05).②The OSAHS group primarily presented with blockade of wind-phlegm-static blood syndrome(43.2%),whereas the non-OSAHS group showed upward disturbance of wind-fire syndrome(31.3%).The distribution of TCM syndromes between the two groups showed statistically significant differences(P<0.05).③Patients in the OSAHS group had higher NIHSS scores than those in the non-OSAHS group(P<0.05).④Of the 145 AIS patients,90 were classified as mild and 55 as non-mild.Mild AIS patients showed higher LSpO2 values than non-mild AIS patients(P<0.05).However,there were no statistically significant differences in AHI values between the two groups(P>0.05).⑤Significant differences were observed in AHI and LSpO2 values among AIS patients with different TCM syndromes(H=27.614,P<0.05;H=20.939,P<0.05).Further pairwise comparisons revealed that patients with blockade of wind-phlegm-static blood syndrome had the highest AHI values and the lowest LSpO2 values(P<0.05).⑥Binary logistic regression analysis indicated that the severity of OSAHS[OR=0.635,95%CI(0.419~0.962),P<0.05]was an independent predictor for the upward disturbance of wind-fire syndrome.Gender[OR=3.986,95%CI(1.178~13.488),P<0.05],AHI[OR=1.090,95%CI(1.046~1.136),P<0.05],and severity of OSAHS[OR=3.162,95%CI(2.073~4.824),P<0.05]were independent predictors for the blockade of wind-phlegm-static blood syndrome.Gender[OR=0.225,95%CI(0.060~0.850),P<0.05]and BMI[OR=1.170,95%CI(1.025~1.335),P<0.05]were independent predictors for the qi deficiency and blood stasis syndrome.AHI[OR=0.907,95%CI(0.826~0.996),P<0.05]was an independent predictor for the stirring wind due to yin deficiency syndrome.Conclusions In AIS patients with OSAHS,the blockade of wind-phlegm-static blood syndrome was the most common.These patients had higher AHI values and more severe nocturnal hypoxemia.Gender,BMI,AHI,and the severity of OSAHS were correlated with the TCM syndrome differentiation in AIS patients with OSAHS.These findings provide valuable insights for TCM-based diagnosis and treatment of AIS patients with OSAHS.