低氧血症对阻塞性睡眠呼吸暂停低通气综合征合并难治性高血压的影响  

Effect of hypoxemia on patients with obstructive sleep apnea hypopnea syndrome complicated with refractory hypertension

作　　者：谢容秀 周文旭 李加樱 周晨 朱涛峰 XIE Rongxiu;ZHOU Wenxu;LI Jiaying;ZHOU Chen;ZHU Taofeng(Department of General Medicine,Yixing Hospital Affiliated to Jiangsu University,Yixing,Jiangsu 214200,China;Department of Respiratory and Critical Care Medicine,Yixing Hospital Affiliated to Jiangsu University,Yixing,Jiangsu 214200,China)

机构地区：[1]江苏大学附属宜兴医院全科医学科,江苏宜兴214200 [2]江苏大学附属宜兴医院呼吸与危重症医学科,江苏宜兴214200

出　　处：《临床肺科杂志》2024年第9期1354-1359,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的 分析比较多导睡眠监测(PSG)各项低氧血症指标与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并难治性高血压(RH)的相关性强弱,及其对OSAHS患者合并RH的诊断价值。方法 回顾性收集2019年1月1日至2023年6月30日在江苏大学附属宜兴医院确诊的OSAHS患者,将所有患者分为病例组(合并RH,n=127)和对照组(不合并RH,n=406)。使用Logistic回归分析低氧血症指标与OSAHS患者合并RH的相关性,并进一步对各项指标进行四分位数分类,分别以第一四分位数水平作为参考,比较不同水平的低氧指标与RH之间的关系。采用受试者工作曲线(ROC)评价低氧血症对OSAHS患者合并RH的诊断价值。结果 两组的性别、体重、BMI、颈围、腰围、ESS评分、TC、AHI、ODI、T90%、LSaO_(2)和MSaO_(2)水平有统计学差异(P<0.05)。校正各项混杂因素后的多因素Logistic回归分析结果表明,T90%(OR=1.034,95%CI 1.014~1.055)、ODI(OR=1.026,95%CI 1.008~1.044)、LSaO_(2)(OR=0.969,95%CI 0.945~0.992)和MSaO_(2)(OR=0.834,95%CI 0.742~0.937)均是RH发生的独立危险因素,其中T90%的风险最高(P<0.05)。进一步对T90%、ODI、LSaO_(2)和MSaO_(2)进行四分位数分类,结果显示,随着T90%、ODI的升高以及LSaO_(2)、MSaO_(2)的降低,RH的风险逐渐增加。ROC曲线表明,T90%、ODI、LSaO_(2)、MSaO_(2)以及四项指标联合预测RH风险的曲线下面积(AUC)分别为0.764,0.718,0.668,0.720,0.743。结论 T90%、ODI升高及LSaO_(2)、MSaO_(2)降低是OSAHS合并RH的独立危险因素,并对RH的发生具有诊断价值。与ODI、LSaO_(2)、MSaO_(2)相比,T90%能更好地诊断OSAHS合并RH的发生。Objective To analyze and compare the correlation between various hypoxemia indexes of polysomnography monitoring(PSG)and obstructive sleep apnea-hypopnea syndrome(OSAHS)complicated with refractory hypertension(RH),and its diagnostic value in patients with OSAHS complicated with RH.Methods Patients with OSAHS diagnosed in Yixing Hospital affiliated with Jiangsu University from January 1,2019 to June 30,2023 were retrospectively collected,and all patients were divided into case group(with RH,n=127)and control group(without RH,n=406).Logistic regression was used to analyze the correlation between hypoxemia indexes and RH in OSAHS patients,and then the indexes were further classified into quartiles,and the relationship between different levels of hypoxia indexes and RH was compared with the first quartile level as a reference.To evaluate the diagnostic value of hypoxemia in patients with OSAHS complicated with RH by receiver working curve(ROC).Results There were significant statistical differences in gender,weight,BMI,neck circumference,waist circumference,ESS score,TC,AHI,ODI,T90%,LSaO_(2) and MSaO_(2) levels between the two groups(P<0.05).The results of multivariate logistic regression analysis after adjusting various confounding factors showed that T90%(OR=1.034,95%CI 1.014~1.055),ODI(OR=1.026,95%CI 1.008~1.044),LSaO_(2)(OR=0.969,95%CI 0.945~0.992),MSaO_(2)(OR=0.834,95%CI 0.742~0.937)were all independent risk factors for RH,and the risk of T90%was the highest(P<0.05).Further quartile classification of T90%,ODI,LSaO_(2),and MSaO_(2) showed that with the increase of T90%and ODI and the decrease of LSaO_(2) and MSaO_(2),the risk of RH gradually increased.The ROC curve analysis results showed that the area under the curve(AUC)of T90%,ODI,LSaO_(2),MSaO_(2),and the four indicators jointly predicting RH risk were 0.764,0.718,0.668,0.720,and 0.743,respectively.Conclusion The increase of T90%and ODI,and the decrease of LSaO_(2) and MSaO_(2) are independent risk factors for OSAHS with RH and have diagnostic value for the oc

关 键 词：低氧血症 难治性高血压 阻塞性睡眠呼吸暂停 

分 类 号：R766[医药卫生—耳鼻咽喉科] R544.1[医药卫生—临床医学]