阻塞性睡眠呼吸暂停低通气综合征对高血压患者早期动脉硬化度评估指数的影响  

Effect of obstructive sleep apnoea syndrome on early arterial stiffness in essential hypertensive subjects

作　　者：王勇[1] 朱源生[1] 周亚林[1] 郑玉龙[1] 张能锋[1] 王洪雷[1] 

机构地区：[1]徐州医学院附属淮安医院心内科,江苏淮安223002

出　　处：《现代医学》2013年第5期315-319,共5页Modern Medical Journal

基　　金：江苏省卫生厅科技项目(Z200913)

摘　　要：目的:探讨原发性高血压合并阻塞性睡眠呼吸暂停低通气综合征(EH+OSAS)对早期动脉硬化度评估指数如颈动脉内膜中层厚度(CIMT)、肱踝脉搏波传导速度(baPWV)、冠状动脉钙化积分(CACS)的影响。方法:病例选择:EH+OSAS者80例;单纯EH组82例。两组患者分别进行多导睡眠监测(PSG),CIMT、baPWV、CACS检查,观察两组患者的CIMT、baPWV、CACS变化。结果:(1)与单纯EH组相比,EH+OSAS组中最低血氧饱合度(SaO2)(75.6±4.3 vs 90.2±1.0,P=0.02)显著降低,SaO2<90%(%TST)(29.2±1.6vs 0±0,P=0.01)明显增加,差异有统计学意义(P<0.05)。(2)EH+OSAS组患者CIMT(1.29±0.32 vs1.03±0.25 mm)、baPWV(1 484.56±103.42 vs 1 251.26±84.46 m.s-1)、CACS(157.85±204.63 vs62.58±102.47)明显高于单纯EH组,差异有统计学意义(P<0.05)。(3)EH+OSAS患者睡眠呼吸暂停低通气指数(AHI)与CIMT、baPWV、CACS呈正相关(r=0.287,0.242和0.278,均P<0.05),差异有统计学意义。结论:作为早期动脉硬化度评估指数CIMT、baPWV、CACS与睡眠呼吸暂停的严重程度相关。Objective： To investigate whether essential hypertensive （EH） patients with obstructive sleep apnoea syndrome（ OSAS ） are characterized by increased arterial stiffness, such as carotid intima- media thickness （CIMT）, brachial ankle pulse wave velocity（baPWV） and coronary artery calcification score（CACS）. Methods： Our study population consisted of 80 consecutive patients with newly diagnosed untreated essential hypertension suffering from OSAS and 82 hypertensive patients without OSAS, matched for age, sex, and smoking status. All subjects underwent polysomnography （PSG） and arterial stiffness evaluation by means of CIMT, baPWV and CACS measurements. Results： Hypertensive subjects with OSAS [ apnoea/hypopnoea index （AHI） t〉5 ] compared with hypertensive subjects without OSAS （AHI 〈 5 ） demonstrated decreased levels of minimum oxygen saturation （SaO2） （75.6 ± 4.3 versus 90.2 ± 1.0, P = 0.02）, and increased percentage of SaO2 less than 90 percentage （29.2 ± 1.6 versus 0 ±0,P = 0.01 ）. Hypertensive subjects with OSAS compared with those without OSAS had significantly increased CIMT[ （ 1.29 ± 0.32） versus （ 1.03 ± 0.25 ） mm, P = 0.03 ], baPWV [ （ 1 484.56 ± 103.42） versus （1 251.26 ±84.46） m s-1 ,P=0.01] and CACS （157.85 ± 204.63 versus 62.58 ± 102.47, P = 0.02 ） and this difference remained significant even after adjustment for confounders （ all P 〈 0.05 ）. In hypertensive subjects with OSAS , CIMT, baPWV and CACS were positive correlated with AHI （r = 0. 287, 0. 242 and 0. 278, respectively, all P 〈 0.05 ）. Conclusion： This finding suggests that OSAS has a significant aggravated effect on arterial stiffening in the setting of essential hypertensive subjects.

关 键 词：原发性高血压合并阻塞性睡眠呼吸暂停低通气综合征 颈动脉内膜中层厚度 肱踝脉搏波传导 速度 冠状动脉钙化积分 

分 类 号：R544.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]