阻塞性睡眠呼吸暂停相关性高血压患者酒精摄入后夜间血氧变化研究  

Relationship between alteration of nocturnal oxygen saturation and alcohol intake in OSA-related hypertensive population

作　　者：王瑛[1] 洪静[1] 姚晓光[1] 汪迎春[1] 胡君丽[1] 周克明[1] 李南方[1] WANG Ying;HONG Jing;YAO Xiao-guang;WANG Ying-chun;HU Jun-li;ZHOU Ke-ming;LI Nan-fang(Hypertension Center of the People’s Hospital of Xinjiang Uygur Autonomous Region,Hypertension Institute of Xinjiang,NHC Key Laboratory of Hypertension Clinical Research,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院高血压中心新疆高血压研究所国家卫生健康委员会高血压诊疗研究重点实验室,新疆乌鲁木齐830001

出　　处：《中国实用内科杂志》2020年第8期650-656,共7页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金项目(81650001)。

摘　　要：目的明确单次酒精摄入对睡眠呼吸暂停程度及相关参数的影响,并进一步探讨影响酒精摄入后阻塞性睡眠呼吸暂停(OSA)严重程度的相关指标。方法纳入2015年4月至2016年9月新疆维吾尔自治区人民医院高血压诊疗研究中心符合诊断标准的年龄≥18岁的男性患者共61例,分别在饮酒前和饮酒后进行2次睡眠呼吸监测(PSG),并于饮酒前、饮酒后PSG前抽取静脉血进行酒精浓度测定。按照酒精浓度与年龄进行分组,分别比较饮酒前后睡眠参数的差异,观察酒精对OSA相关性高血压的影响。结果所有参与者摄入酒精后呼吸暂停低通气指数(AHI)增加[25.0(7.8,47.0)对25.4(14.6,47.2),P=0.038]、呼吸暂停指数(AI)增加[5.6(1.1,25.9)对7.4(2.9,26.6),P=0.008],最低血氧饱和度(SPO2)降低[79.0(74.5,83.0)对74.5(69.8,81.0),P<0.001];按照酒精摄入后AHI前后相比差值的不同分为ΔAHI>0(44例)组与ΔAHI<0(17例)组,ΔAHI>0组酒精摄入后AHI指数增加[17.5(6.9,38.5)对27.7(15.4,48.8),P<0.001];ΔAHI<0组酒精摄入后AHI指数降低[41.6(23.5,66.7)对18.2(12.5,31.8),P<0.001];两组最低SPO2均降低[81.0(72.0,84.0)对73.0(70.0,78.0),P<0.001]、[79.0(75.0,82.0)对75.0(67.0,78.0),P=0.037]。此外,酒精浓度≥10.68mmol/L组患者的血压水平在酒精摄入后降低,在酒精浓度<10.68 mmol/L的组中酒精摄入后AHI、AI、HI升高,而两组的最低SPO2均降低。在年龄分组中,年龄≥44岁组饮酒前后AHI、AI、最低SPO2存在差异,而年龄<44岁组中仅最低SPO2存在差异。多元线性逐步回归分析发现,体重指数(BMI)、酒精摄入后收缩压影响酒精浓度<10.68 mmol/L人群的最低SPO2,BMI、夜间平均心率影响酒精浓度≥10.68 mmol/L人群的最低SPO2。结论单次酒精摄入后最低血SPO2可能更好地反映对高血压合并OSA人群严重程度的影响,且在不同酒精浓度与年龄分组中酒精摄入后最低SPO2存在改变。Objective To determine the effect of single alcohol intake on sleep apnea and related parameters,and to further explore the relevant indicators that affect the severity of OSA after alcohol intake.Methods A total of 61 male hypertensive patients aged≥18 years who were admitted to the Hypertension Diagnosis and Treatment Research Center of the People’s Hospital of Xinjiang Uygur Autonomous Region from April 2015 to September 2016 were included in the study,and they received Polysomnography(PSG)before and after drinking,respectively.Venous blood was taken before drinking and after drinking but before PSG for alcohol concentration determination.After alcohol intake,the differences in AHI were divided into two groups:ΔAHI>0 andΔAHI<0.The patients were divided into groups according to alcohol concentration and age.The differences in sleep parameters before and after drinking alcohol were compared to observe the effect of alcohol on OSArelated hypertension.Results In the total study population,the AHI(apnea hypopnea index)increased after alcohol intake[25.0(7.8,47.0)vs.25.4(14.6,47.2),P=0.038],and the AI(apnea index)increased[5.6(1.1,25.9)vs.7.4(2.9,26.6),P=0.008],the minimum oxygen saturation decreased[79.0(74.0,83.0)vs.74.5(69.8,81.0),P<0.001];according to different AHI difference the patients were divided intoΔAHI>0 group(n=44)andΔAHI<0 group(n=17).In the group withΔAHI>0,the AHI index increased after alcohol intake[17.5(6.9,38.5)vs.27.7(15.4,48.8),P<0.001];in the group withΔAHI<0,the AHI decreased after alcohol intake[41.6(23.5,66.7)vs.18.2(12.5,31.8),P<0.001],and the minimum oxygen saturation of the two groups decreased[81.0(72.0,84.0)vs.73.0(70.0,78.0),P<0.001],[79.0(75.0,82.0)vs.75.0(67.0,78.0),P=0.037].In addition,the blood pressure level decreased after alcohol intake in the group with alcohol concentration≥10.68 mmol/L(49.13 mg/100 mL),while the AHI,AI,HI index increased after alcohol intake in the group with alcohol concentration<10.68 mmol/L,and the minimum blood oxygen saturation decreased in b

关 键 词：酒精 阻塞性睡眠呼吸暂停综合征 高血压 最低血氧饱和度 

分 类 号：R563.9[医药卫生—呼吸系统]