老年患者阻塞性睡眠呼吸暂停综合征严重性与血压和血糖及周围动脉硬化的关系  

Correlation of OSAS with blood pressure,diabetes mellitus and periferal atherosclerosis in elderly patients

作　　者：苏琳[1] 张庆文[1] 李卫[1] 宝辉[1] 周全[1] 康丽萍[1] 杨素敏[1] 郭远[1] 韩芳[2] 

机构地区：[1]北京大学人民医院老年科,100044 [2]北京大学人民医院呼吸与危重症医学科,100044

出　　处：《中华老年心脑血管病杂志》2015年第5期475-478,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年患者阻塞性睡眠呼吸暂停综合征（OSAS）的严重性与周围动脉硬化、高血压、糖尿病的关系。方法选择2010年1月-2014年10月北京大学人民医院老年科收治的113例经睡眠监测检查证实且尚未接受治疗的老年OSAS患者,按照睡眠呼吸暂停低通气指数（AHI）分为轻度OSAS组32例、中度OSAS组33例、重度OSAS组48例;选择年龄、性别、吸烟情况与OSAS患者匹配的40例为对照组。均行颈动脉及下肢股动脉超声检查,24h血压监测,检测糖化血红蛋白等指标。结果与对照组比较,轻度OSAS组、中度OSAS组和重度OSAS组2型糖尿病及高血压的发病率显著升高,差异有统计学意义（P〈0.05,P〈0.01）;重度OSAS组2型糖尿病的发病率高于轻度OSAS组（50.0%vs 28.1%,P〈0.05）。重度OSAS组体质量指数、高脂血症及脂肪肝发生率高于对照组[（27.7±3.1）kg/m^2 vs（24.4±2.5）kg/m^2、68.8%vs 40.0%及56.3%vs 27.5%,P〈0.05]。中度OSAS组及重度OSAS组24h平均收缩压、白昼收缩压、夜间收缩压、醒后收缩压、醒后舒张压高于对照组,差异有统计学意义（P〈0.05）。多元逐步回归分析显示,颈动脉及下肢动脉不稳定斑块发生率与AHI呈正相关（P〈0.05）。结论严重的OSAS患者更易出现高血压、2型糖尿病、高脂血症,颈动脉及下肢动脉不稳定斑块。Objective To study the correlation of OSAS with periferal atherosclerosis,hypertension,and diabetes mellitus（DM）in elderly patients.Methods One hundred and thirteen elderly OSAS patients admitted to our hospital from January 2010 to October 2014 served as an experimental group and were further divided into mild OSAS group（n=32）,moderate OSAS group（n=33）and severe OSAS group（n=48）according to their AHI.Forty age-,sex-and smokingmatched subjects served as a control group.The patients underwent femoral artery ultrasonography.Their 24 hblood pressure and serum HbA1 clevel were measured.Results The incidence of T2 DM and hypertension was significantly higher in mild,moderate and severe OSAS groups than in control group（P〈0.05,P〈0.01）.The incidence of T2 DM was significantly higher in severe OSAS group than in mild OSAS group（P〈0.05）.The BMI and the incidence of hyperlipemia and fatty liver were significantly higher in severe OSAS group than in control group（P〈0.05）.The24 hmean systolic blood pressure（SBP）,daylight SBP,night SBP,vigil SBP and diastolic BP were significantly higher in moderate and severe OSAS groups than in control group（P〈0.05）.Multivariate logistic regression analysis showed that unstable plaques in carotid and femoral arteries were positively correlated with AHI（P〈0.05）.Conclusion Hypertension,T2 DM,hyperlipemia,and unstable plaques in carotid and femoral arteries are easier to occur in severe OSAS patients.

关 键 词：睡眠呼吸暂停 阻塞性 动脉硬化 高血压 糖尿病 高脂血症 

分 类 号：R766[医药卫生—耳鼻咽喉科]