阻塞性睡眠呼吸暂停与原发性醛固酮增多症共病的临床特征分析  

Clinical Characteristics of Obstructive Sleep Apnea and Comorbid Primary Aldosteronism

作　　者：沈阳阳 朱婕 时媛 谭璐[1] 李桃美 雷飞[1] 唐向东[1] SHEN Yang-yang;ZHU Jie;SHI Yuan;TAN Lu;LI Tao-mei;LEI Fei;TANG Xiang-dong(Sleep Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院睡眠医学中心,成都610041

出　　处：《四川大学学报（医学版）》2023年第2期304-309,共6页Journal of Sichuan University(Medical Sciences)

基　　金：科技部科技创新2030-“脑科学与类脑研究”重大项目(No.2021ZD0201900);国家自然科学基金(No.82120108002、No.U21A20335)资助。

摘　　要：目的 探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与原发性醛固酮增多症(primary aldosteronism, PA)共病的疾病特征,并进一步探索影响血浆醛固酮浓度的相关因素。方法 回顾性分析2016年1月–2021年12月于四川大学华西医院确诊PA的住院患者105例,根据多导睡眠图(polysomnography, PSG)结果分为PA共病单纯性打鼾组(20例)、PA共病OSA组(85例),后者以呼吸暂停低通气指数(apnea-hypopnea index, AHI)分轻(31例)、中(24例)、重(30例)亚组。并纳入诊断单纯OSA的门诊患者85例作为对照组。分别比较组间的人口学、临床特征、生化指标和PSG参数等资料。结果 与单纯OSA患者相比:OSA共病PA患者的高血压占比增高,其收缩压、舒张压水平亦增高(P<0.05);OSA共病PA患者的AHI增加,平均血氧饱和度和睡眠效率降低(P<0.05)。随OSA严重程度的加重,PA患者的体质量指数、胆固醇、低密度脂蛋白、血尿酸水平升高。线性回归分析提示,最低血氧饱和度与血浆醛固酮浓度呈负相关(β=-0.222,P=0.045)。结论 与PA共病可加重OSA表现。OSA会加重PA患者的脂代谢及尿酸代谢指标异常。共病患者的血浆醛固酮浓度受最低血氧饱和度水平的影响。Objective To explore the characteristics of patients with obstructive sleep apnea(OSA) and comorbid primary aldosteronism(PA) and to explore the relevant factors affecting plasma aldosterone concentration.Methods A total of 105 patients diagnosed with PA and admitted at West China Hospital, Sichuan University between January 2016 and December 2021 were retrospectively analyzed. The subjects were divided into a PA with comorbid snoring group(n=20) and a PA with comorbid OSA group(n=85) based on the results of polysomnography(PSG). The PA with comorbid OSA group was further divided into mild, moderate, and severe subgroups according to the apneahypopnea index(AHI). A total of 85 outpatients diagnosed with OSA were included as the control group. Demographic,clinical, biochemical, and PSG data were compared between the groups. Results Compared with patients with only OSA, a significantly higher proportion of patients with OSA and comorbid PA had hypertension and elevated levels of systolic and diastolic blood pressure(P<0.05). In addition, patients with OSA and comorbid PA had significantly increased AHI and significantly decreased mean oxygen saturation and sleep efficiency(P<0.05). The more severe the OSA was, the higher levels of BMI, cholesterol, low-density lipoprotein, and uric acid the PA patients had. Linear regression analysis showed that the lowest oxygen saturation(β=-0.222, P=0.045) was negatively correlated with plasma aldosterone concentration. Conclusion Comorbidity with PA can aggravate the clinical manifestations of OSA, while OSA further disrupted the metabolism of lipids and uric acid in PA patients. Plasma aldosterone concentrations in patients with comorbid OSA and PA were affected by the lowest oxygen saturation level.

关 键 词：阻塞性睡眠呼吸暂停 原发性醛固酮增多症 醛固酮 

分 类 号：R766[医药卫生—耳鼻咽喉科] R586.24[医药卫生—临床医学]