高血压人群中阻塞性睡眠呼吸暂停及性别对肾小球滤过率的影响  

Effects of Obstructive Sleep Apnea and Gender on Glomerular Filtration Rate in Hypertensive Population

作　　者：王瑛[1] 洪静[1] 姚晓光[1] 汪迎春[1] 李南方[1] WANG Ying;HONG Jing;YAO Xiaoguang;WANG Yingchun;LI Nanfang(Department of Hypertension Center,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诊疗研究中心,新疆高血压研究所,国家卫生健康委高血压诊疗研究重点实验室,乌鲁木齐830001

出　　处：《中国医学科学院学报》2022年第3期403-410,共8页Acta Academiae Medicinae Sinicae

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202031)。

摘　　要：目的探讨高血压人群中阻塞性睡眠呼吸暂停(OSA)及性别与估算肾小球滤过率(eGFR)的相关性。方法2005年2月至2010年8月间在高血压诊疗研究中心就诊的高血压患者2064例,均行整夜多导睡眠呼吸监测。根据睡眠呼吸暂停低通气指数(AHI)分为高血压合并OSA组与单纯高血压组,比较两组患者在不同性别中的临床特征及睡眠监测指标。采用多因素Logistic回归对eGFR的影响因素进行分析。结果2064例高血压患者中,男性1537例,合并OSA患者1221例;女性527例,合并OSA患者350例。男性OSA患病率(χ^(2)=36.631,P<0.001)、舒张压(Z=-7.776,P<0.001)均明显高于女性,而eGFR(Z=-3.010,P=0.003)明显低于女性。男性AHI(Z=-8.727,P<0.001)、呼吸暂停指数(Z=-9.252,P<0.001)、低通气指数(HI)(Z=-4.868,P<0.001)均明显高于女性,而最低血氧饱和度(t=-3.325,P=0.001)明显低于女性。在不同性别组中,与单纯高血压组相比,高血压合并OSA组患者的eGFR明显降低,差异有统计学意义(Z=-27.434,P<0.001;Z=-18.762,P<0.001)。男性人群中HI与eGFR呈负相关(r=-0.006,P=0.017),女性人群中AHI、HI与eGFR呈负相关(r=-0.108,P=0.013;r=-0.094,P=0.032)。经校正后,Logistic回归分析显示,OSA和氧减指数4分别是男女高血压患者eGFR降低的危险因素(OR=1.383,95%CI=1.010~1.905,P=0.045;OR=1.013,95%CI=1.002~1.024,P=0.021)。结论高血压患者合并OSA后eGFR降低,且OSA和氧减指数分别是男女高血压患者eGFR降低的危险因素。Objective To explore the associations of obstructive sleep apnea(OSA)and gender with estimated glomerular filtration rate(eGFR)in hypertensive populations.Methods From February 2005 to August 2010,2064 hypertensive patients who were treated in the Department of Hypertension Center underwent overnight polysomnographic monitoring.According to the apnea-hypopnea index(AHI),they were assigned into an hypertension combined with OSA group and a hypertension group.The clinical characteristics and sleep monitoring indicators were compared between different genders and between the two groups.Multivariate Logistic regression was employed to analyze the influencing factors of eGFR.Results Among the 2064 hypertensive patients,there were 1537 males(including 1221 patients with OSA)and 527 females(including 350 patients with OSA).The males had higher prevalence of OSA(χ^(2)=36.631,P<0.001)and diastolic blood pressure(Z=-7.776,P<0.001)and lower eGFR(Z=-3.010,P=0.003)than the females.The males had higher AHI(Z=-8.727,P<0.001),apnea index(Z=-9.252,P<0.001),hypopnea index(HI)(Z=-4.868,P<0.001)than the females,and the lowest oxygen saturation(t=-3.325,P=0.001)was significantly lower in males than in females.The hypertension combined with OSA group showed lower eGFR than the hypertension group(Z=-27.434,P<0.001;Z=-18.762,P<0.001).HI was negatively correlated with eGFR in the male population(r=-0.006,P=0.017),and AHI and HI were negatively correlated eGFR in females(r=-0.108,P=0.013;r=-0.094,P=0.032).After adjustment,Logistic regression showed that OSA and oxygen desaturation index 4 were the risk factors for the reduction of eGFR in hypertensive patients in males and females,respectively(OR=1.383,95%CI=1.010-1.905,P=0.045;OR=1.013,95%CI=1.002-1.024,P=0.021).Conclusion OSA lowers the eGFR of hypertensive patients,and OSA and oxygen desaturation index are the risk factors for the decrease in eGFR in male and female hypertensive patients,respectively.

关 键 词：阻塞性睡眠呼吸暂停 肾小球滤过率 高血压 呼吸暂停低通气指数 

分 类 号：R546[医药卫生—心血管疾病]