老年阻塞性睡眠呼吸暂停患者血管内皮功能和心脑血管事件的相关性  

The effect of obstructive sleep apnea syndrome on vascular endothelial function and cardiovascular events in elderly patients

作　　者：刘剑南[1] 傅坤发[2] 丁林峰[3] 顾建华[1] 丁明[1] 陆甘[1] 

机构地区：[1]江苏省老年医院呼吸科,南京210024 [2]江苏省老年医院干部保健科,南京210024 [3]江苏省老年医院心功能科,南京210024

出　　处：《中华老年医学杂志》2010年第1期5-8,共4页Chinese Journal of Geriatrics

基　　金：基金项目：江苏省卫生厅面上科研项目（H200731）

摘　　要：目的回顾性分析老年阻塞性睡眠呼吸暂停综合征（OSAS）患者的血管内皮功能和心脑血管事件的相关性及对预后的影响。方法OSAS患者79例（OSAS组），老年OSAS组和非老年OSAS组分别为39例和40例；排除OSAS诊断的老年患者60例（老年非OSAS组）。通过电话和门诊进行随访，随访时间中位数25个月。所有患者均接受：（1）彩色多普勒超声测定肱动脉血流介导的血管舒张功能（FMD）；（2）检查和测定睡眠呼吸事件、血清生化指标；（3）随访心脑血管事件。结果（1）老年0SAS组FMD低于老年非0SAS组（P〈0．05）。（2）老年SSAS组体质指数高于老年非OSAS组（P〈0．01），最低血氧饱和度、平均血氧饱和度低于老年非OSAS组（P〈0．01，P〈0．05）。多因素Logistic回归分析结果显示，空腹血糖升高是FMD主要危险因素（OR=1．83，95％CI：1．11～3．03），其次是最低血氧饱和度（OR=0．92，95％CI：0．85～1．00）。（3）老年0SAS组心脑血管事件发生率高于非老年OSAS组和老年非OSAS组（x2=7．339，P〈0．05）。多因素Logistic回归分析结果显示，FMD与患者预后密切相关（OR=1．33，95％CI：1．06～1.66），其次是超敏C反应蛋白（0R=0．51，95％CI：0．34～0．76）。结论老年OSAS患者血管内皮功能受损更为严重，心脑血管事件发生率增加。OSAS可能通过间歇低氧和炎性反应等多种机制损伤血管内皮功能，参与影响患者预后。Objective To retrospectively analyze the cardiovascular outcomes of the elderly patients with obstructive sleep apnea syndrome （OSAS） and the influence factors. Methods According to polysomnography examination, 79 OSAS patients and 60 patients without OSAS were selected and divided into 3 groups： elder OSAS group [39 patients older than 65 years, respiratory apnea index （AHI）≥5], non-elder OSAS group （40 patients less than 65 years old, AHI≥5） and elder control group （60 patients older than 65 years, AHI≥5）. All patients were followed up by telephone and clinic consulting. The median follgw-up duration was 25 months. All patients received the following studies： （1）Flow-mediated vasodilation （FMD）, which was assessed by high-resolution ultrasound technique. （2） The sleep-related breathing events and serum biochemical indexes. （3） The death due to cardiovascular disease （CVD）, angina, myocardial infarction and stroke. Results （1） FMD was significantly lower in elder OSAS group than in elder control group （P〈0.01）. （2）In elder OSAS group versus elder control group, BMI was significantly higher （P〈0.01）, while both lowest pulse oxygen saturation （LSpO2） and mean series pulse oximeter （MeanSpO2） were significantly lower （P〈0.01 and P〈0.05, respectively）. Multiple logistic regression analysis showed that impaired fasting plasma glucose was the primary injury factor for FMD （OR=1. 83, 95% CI：1. 11-3.03）, and LSpO2 was the secondary injury factor （OR=0.92, 95% C[：0.85-1.00）. （3） Theincidence of cardiovascular events in the 3 groups： the incidence of cardiovascular events was significantly higher in eider OSAS group than in the other 2 groups （X2= 7. 339, P〈0.05）. Multiple logistic regression analysis showed that FMD （OR=1. 33, 95% CI： 1.06-1.66）and hs-CRP （OR= 0.51, 95% CI： 0. 34-0.76） were closely related with prognosis. Conclusions Compared with non-elder OSAS group and elder control group, vascular end

关 键 词：睡眠呼吸暂停 阻塞性 内皮 血管 

分 类 号：R766[医药卫生—耳鼻咽喉科]