杨丽娟, 薛建华, 陆燕. 阻塞性睡眠呼吸暂停低通气综合征患者患动脉粥样硬化性心血管病风险及影响因素[J]. 职业卫生与应急救援, 2022, 40(1): 21-25. DOI: 10.16369/j.oher.issn.1007-1326.2022.01.005
引用本文: 杨丽娟, 薛建华, 陆燕. 阻塞性睡眠呼吸暂停低通气综合征患者患动脉粥样硬化性心血管病风险及影响因素[J]. 职业卫生与应急救援, 2022, 40(1): 21-25. DOI: 10.16369/j.oher.issn.1007-1326.2022.01.005
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YANG Lijuan, XUE Jianhua, LU Yan. Risk prediction of atherosclerotic cardiovascular disease of patients with obstructive sleep apnea hypopnea syndrome[J]. Occupational Health and Emergency Rescue, 2022, 40(1): 21-25. DOI: 10.16369/j.oher.issn.1007-1326.2022.01.005
Citation: YANG Lijuan, XUE Jianhua, LU Yan. Risk prediction of atherosclerotic cardiovascular disease of patients with obstructive sleep apnea hypopnea syndrome[J]. Occupational Health and Emergency Rescue, 2022, 40(1): 21-25. DOI: 10.16369/j.oher.issn.1007-1326.2022.01.005
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阻塞性睡眠呼吸暂停低通气综合征患者患动脉粥样硬化性心血管病风险及影响因素

Risk prediction of atherosclerotic cardiovascular disease of patients with obstructive sleep apnea hypopnea syndrome

    摘要
  • 摘要:
      目的  通过China-PAR模型，评估阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者罹患动脉粥样硬化性心血管病（atherosclerotic cardiovascular disease，ASCVD）的10年风险及终生风险，进行心脑血管病的一级预防。
      方法  选择2020年1—12月从上海市部分事业单位筛查出的248例有打鼾症状者为研究对象，采集研究对象基本体检资料；使用Ⅲ级便携式睡眠监测诊断OSAHS，记录呼吸暂停低通气指数（apnea hypopnea index，AHI）、血氧低于90%占总监测时间百分比（TS90%）等参数。按照AHI数据将对象分为单纯鼾症组（51例）、轻度OSAHS组（79例）、中度OSAHS组（79例）、重度OSAHS组（39例）。采用多元线性回归分析OSAHS各睡眠参数与China-PAR模型下的ASCVD风险评分的关系。
      结果  OSAHS患者年龄较单纯鼾症组高，男性发生OSAHS风险较高（P＜0.05）；OSAHS患者腰围较粗，且随OSAHS严重程度的增加而增粗（P＜0.05）。OSAHS合并高血压比例较高，收缩压、舒张压均较单纯鼾症组高（P＜0.05）。OSAHS组的China-PAR评分均明显高于单纯鼾症组（P＜0.05）。OSAHS程度越高，对应患者ASCVD终生风险也越高（P＜0.05）。回归分析结果显示：（1）TS90%每增加1%，ASCVD10年风险增加11.4%（P = 0.007）；（2）TS90%每增加1%、AHI每小时增加1次，ASCVD终生风险分别增加37.3%、13.1%（P＜0.001）。
      结论  OSAHS与心脑血管风险密切相关，中、重度OSAHS人群更应关注心脑血管病的终生风险。要关注OSAHS患者整夜睡眠过程中血氧饱和度＜90%的时间段，TS90%是10年心血管病风险、终生风险的独立危险因素，可作为早期干预OSAHS治疗有效性的评估指标。

     

    Abstract:
      Objective  To evaluate the 10-year risk and lifetime risk of atherosclerotic cardiovascular disease(ASCVD)of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and furthermore to carry out the primary prevention of cardiovascular and cerebrovascular diseases.
      Methods  Totally 248 patients with snoring symptoms screened by regular physical examination from January to December 2020 were studied. Grade Ⅲ portable sleep monitoring was used to diagnose OSAHS and parameters such as apnea hypopnea index(AHI)and percentage of blood oxygen less than 90% in total monitoring time (TS90%) were recorded. According to AHI data, the subjects were divided into simple snoring group (51 cases), mild OSAHS group (79 cases), moderate OSAHS group(79 cases), and severe OSAHS group(39 cases). Multiple linear regression was used to analyze the association between OSAHS sleep parameters and ASCVD risk score under China PAR model.
      Results  The age of OSAHS patients was higher than that of simple snoring group and the risk of OSAHS in men was higher(P < 0.05). The waist circumference of OSAHS patients was thicker and increased with OSAHS severity increasing(P < 0.05). The proportion of OSAHS complicated with hypertension, the systolic and diastolic blood pressure were higher than patients in simple snoring group(P < 0.05). The score of China PAR in OSAHS group was significantly higher than that in simple snoring group(P < 0.05). The higher the degree of OSAHS the higher the lifetime risk of ASCVD (P < 0.05). The results of regression analysis showed that: (1)for every 1% increase in TS90 % the annual risk of ASCVD 10 increased by 0.114 (P = 0.007); (2) The lifetime risk of ASCVD increased by 0.373 and 0.131 when TS90% increased by 1% and AHI increased once an hour respectively(P < 0.001).
      Conclusion  OSAHS is closely related to cardiovascular and cerebrovascular risk. The patients with moderate and severe OSAHS should pay more attention to the lifelong risk of cardiovascular and cerebrovascular disease. We should care the OSAHS patients' time when blood oxygen saturation is less than 90% during overnight sleep. TS90% is an independent risk factor for 10-year cardiovascular risk and lifelong risk and it may be a biomarker of effectiveness for early intervention of OSAHS.

     

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