老年人阻塞性睡眠呼吸暂停综合征与心脑血管病关系的探讨  

Relations between senile obstructive sleeping apnea sydrome and cardiocerebral angiopathy

作　　者：陈新华[1] 刘心臣[1] 彭化生 吴祥振 朱明[1] 

机构地区：[1]菏泽医学专科学校,山东省菏泽市274030 [2]菏泽市第三人民医院 [3]定陶县人民医院

出　　处：《中华老年医学杂志》2002年第1期19-22,共4页Chinese Journal of Geriatrics

摘　　要：目的　分析老年人阻塞性睡眠呼吸暂停综合征 (OSAS)相关事件与心、脑血管疾病发病的关系 ,并探讨其发病机制。　方法　采用多导睡眠图 (PSG)监测 ,筛查出OSAS患者 180例 ,分为老年组 97例和非老年组 83例 ,并设老年对照组 82例。观察血压、血糖、血脂、血浆降钙素基因相关肽(CGRP)、内皮素 (ET)等指标 ,并对心、脑血管疾病患病情况进行随访观察 3年。　结果　 (1)老年人反应性差 ,OSAS常见症状与老年人衰老症状相混淆 ,且与多种疾病并存 ,诊断、治疗具有特殊性。 (2 )老年OSAS组PSG监测 ,呼吸紊乱次数 (34 4± 38)、呼吸紊乱指数 (5 9± 10 )、平均呼吸暂停时间 (35± 13)s、最长呼吸暂停时间 (87± 2 6 )s及平均动脉压 (145± 14)mmHg明显高于对照组 (P <0 0 1) ;最低动脉血氧饱和度 (5 5± 13) %明显低于对照组 (P <0 0 1) ,但老年人重症患者少。 (3)OSAS组血糖、血脂、纤维蛋白原、血浆ET均高于对照组 (P <0 0 1) ;血浆CGRP明显低于对照组 (P <0 0 1)。 (4 ) 3年随访中 ,老年OSAS组心血管疾病 78例 ,患病率 80 4 1%;脑血管疾病 6 5例 ,患病率 6 7 0 1%,明显高于非老年组及老年对照组 ,差异有显著性 (P <0 0 1)。　结论　OSAS与心、脑血管病的发病有密切关系 ,是引起OSAS的危险因素之一 。Objective To analyse the pathogenic relations between senile obstructive sleeping apnea syndrome (OSAS) and cardiocerbral angiopathy and also to probe its pathogenic mechanisms. Methods By means of polyguidance sleeping graph (PSG), patients with OSAS were selected and divided into non-elderly, elderly and control groups. Blood pressure, blood glucose, blood fat, plasma calcitonin gene relative peptide (CGRP), ET and other indexes were observed. Three years of observation and follow-up were carried out using cardiocerebral angiopathy. Results (1) The common OSAS symptoms were easily confused with that of senility symptoms since the poor reaction in the elderly patients and the concurrence of different diseases, so the diagnosis and treatment were somewhat special. (2) PSG monitoring, RDN(344±38), AHI(59±10), OSAT(35±13)s, LOSAT(87±26)s, and the mean arterial pressure (145±14)mm Hg in OSAS in the elderly group were significantly higher than those in the control group (P<0.01); the lowest SaO 2 (55±13)% was significantly lower (P<0.01), but fewer severe symptoms happened in the elderly patinets.(3) Blood sugar, blood fat, fibrinogen, plasma ET in OSAS group were higher than those in the control group (P<0.01). Plasma CGRP was significantly lower (P<0.01). (4) Among the 78 OSAS patients with HVD, the morbidity rate was 80.41% while among the 65 patients with CVD, the rate was 67.01%, being significantly higher than that of the non-elderly and control groups (P<0.01). Conclusions OSAS is closely related with the cardiocerebral angiopathy and it is one of the risk factors which have not been emphasized for a long time. The mechanism and the prevention of OSAS is of great importance to the prevention and treatment of cardiocerebral angiopathy .

关 键 词：睡眠呼吸暂停综合征 心血管疾病 脑血管疾病 老年 OSAS PSG 

分 类 号：R54[医药卫生—心血管疾病]