阻塞性睡眠呼吸暂停低通气综合征对老年冠心病患者短期全因死亡的影响  

The effect of obstructive sleep apnea hypopnea syndrome on short-term all-cause death in elderly patients with coronary heart disease

作　　者：谢学刚 何芬 张苗 张松林[1] 和旭梅[1] Xie Xuegang;He Fen;Zhang Miao;Zhang Songlin;He Xumei(Department of Structural Cardiology,The First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Province,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院结构性心脏病科,710061

出　　处：《疑难病杂志》2021年第4期339-343,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省社会发展科技攻关项目(S2015FS1082)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对老年冠心病患者全因死亡的影响。方法选取2015年1月—2016年1月西安交通大学第一附属医院结构性心脏病科收治的老年冠心病患者504例,其中合并OSAHS患者285例纳入观察组,余患者219例纳入对照组。患者出院后每6个月随访1次,随访时间截止于2018年6月,以患者全因死亡为研究终点。收集并比较2组患者临床资料、呼吸功能、心功能、血糖、血脂、炎性因子水平及死亡原因,采用多因素Cox回归模型分析老年冠心病患者死亡危险因素。结果观察组患者低通气指数(AHI)、氧减饱和指数(ODI4)、血氧饱和度低于90%的时间占总监测时间百分比(SIT90)高于对照组(t/χ~2=12.410、18.729、38.823,P均=0.000),体质量指数(BMI)、高敏C反应蛋白(hs-CRP)及白介素-6(IL-6)水平高于对照组(t=5.061、38.063、6.981,P均=0.000),冠心病病死率、全因死亡率高于对照组(χ~2=9.334、15.863,P=0.002、0.000),累计生存率低于对照组(P<0.05),hs-CRP、BMI、OSAHS、SIT90均是老年冠心病患者全因死亡的独立危险因素(P<0.05)。结论 OSAHS是老年冠心病患者全因死亡的独立危险因素,在临床上应引起足够的重视并给予相应的治疗手段。Objective To explore the impact of obstructive sleep apnea hypopnea syndrome(OSAHS)on all-cause death in elderly patients with coronary heart disease(CHD).Methods A total of 504 elderly patients with CHD admitted to the Structural Cardiology Department of the First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to January 2016 were selected.Among them,285 patients with OSAHS were included in the observation group,and the remaining 219 patients were included in the control group.The patients were followed up every 6 months after being discharged from the hospital.The follow-up time ended in June 2018,with all-cause death of the patient as the study endpoint.The clinical data,respiratory function,cardiac function,blood glucose,blood lipids,inflammatory factor levels and causes of death were collected and compared between the two groups of patients,and the multivariate Cox regression model was used to analyze the risk factors of death in elderly patients with CHD.Results The observation group patients’hypoventilation index(AHI),oxygen desaturation index(ODI4),and blood oxygen saturation below 90%of the total monitoring time percentage(SIT90)were higher than those in the control group(t/χ2=12.410,18.729,38.823,P=0.000),body mass index(BMI),high-sensitivity C-reactive protein(hs-CRP)and interleukin 6(IL-6)levels were higher than those of the control group(t=5.001,38.063,6.981,P=0.000).CHD fatality rate,the all-cause mortality rate was higher than that of the control group(χ2=9.334,15.863,P=0.002,0.000),and the cumulative survival rate was lower than that of the control group(P<0.05).hs-CRP,BMI,OSAHS,SIT90 are an independent risk factors for all-cause mortality in elderly patients with CHD(P<0.05).Conclusion OSAHS is an independent risk factor for all-cause death in elderly patients with CHD.It should arouse sufficient attention in clinic and be given corresponding treatment.

关 键 词：冠心病 阻塞性睡眠呼吸暂停低通气综合征 全因死亡 老年人 

分 类 号：R541.4[医药卫生—心血管疾病] R562[医药卫生—内科学]