文献类型：期刊文献

中文题名：老年阻塞性睡眠呼吸暂停低通气相关高血压患者颈动脉粥样硬化的影响因素

英文题名：Carotid atherosclerosis in elderly patients with obstructive sleep apnea hypopnea-associated hypertension:an analysis on influencing factors

作者：王欢欢[1];刘霖[2];高莹卉[3];林俊岭[4];郭静静[5];高岩[6];陈开兵[7];杨玲[1];韩继明[1]

第一作者：王欢欢

机构：[1]延安大学医学院,陕西延安716000;[2]中国人民解放军总医院第二医学中心呼吸与危重症医学科,北京100853;[3]北京大学国际医院睡眠医学中心,北京102206;[4]首都医科大学附属北京朝阳医院睡眠医学中心北京,100124;[5]北京大学人民医院睡眠医学中心,北京100044;[6]中国人民解放军联勤保障部队第960医院全科医学科,济南250000;[7]甘肃中医药大学附属医院睡眠医学中心,兰州730000

第一机构：延安大学医学院,陕西延安716000

年份：2022

卷号：21

期号：6

起止页码：413

中文期刊名：中华老年多器官疾病杂志

外文期刊名：Chinese Journal of Multiple Organ Diseases in the Elderly

收录：CSTPCD

基金：军队保健专项科研基金(19BJZ34);国家老年疾病临床研究中心2018开放课题(NCRCG-PLAGH-2018008);解放军总医院军事医学青年项目(QNC19054)。

语种：中文

中文关键词：老年人;阻塞性睡眠呼吸暂停低通气综合征;高血压;颈动脉粥样硬化;影响因素

外文关键词：aged;obstructive sleep apnea hypopnea syndrome;hypertension;carotid atherosclerosis;influencing factors

摘要：目的探讨老年阻塞性睡眠呼吸暂停低通气(OSAHS)相关高血压患者颈动脉粥样硬化(CAS)发生情况及影响因素。方法连续纳入2015年1月至2017年10月经多导睡眠监测诊断为OSAHS的老年患者(≥60岁)1290例。排除合并糖尿病、其他原因引起的继发性高血压及严重的心脑血管疾病(如房颤、心力衰竭及脑卒中)后,最终纳入老年OSAHS患者755例。根据是否符合2012年中国医师协会制定的OSAHS相关高血压诊断标准,将患者分为高血压组415例及非高血压组340例。根据是否发生CAS,将OSAHS相关高血压患者分为CAS组74例和非CAS组341例。比较2组患者的人口学特征、睡眠参数、血生化与血常规指标及既往病史。采用SPSS 20.0统计软件进行数据分析。采用Spearman相关性分析及多因素logistic回归分析探讨老年OSAHS相关高血压患者CAS的影响因素。结果与非高血压组相比,老年OSAHS相关高血压患者CAS患病率更高[17.8%(74/415)和12.1%(41/340);P<0.05]。与男性相比,女性老年OSAHS相关高血压患者CAS患病率更高[21.0%(34/162)和15.8%(40/253);P<0.05],且CAS疾病患病率主要集中在70~80岁,其次为60~70岁及≥80岁[29.7%(30/101)和13.9%(41/296),16.7%(3/18);P<0.05]。CAS组与非CAS组患者年龄、体质量、体质量指数(BMI)、腰围、吸烟史、饮酒史、收缩压、总睡眠时间(TST)、平均脉搏血氧饱和度(MSpO_(2))、甘油三酯、肌酐、尿酸、平均红细胞血红蛋白浓度(MCHC)、血小板计数(PLT)、白细胞计数(WBC)、消化性溃疡及慢性阻塞性肺疾病(COPD)比较,差异均有统计学意义(均P<0.05)。Spearman相关性分析显示,老年OSAHS相关高血压患者CAS与年龄、吸烟史、饮酒史、收缩压、TST、胃食管反流症、消化性溃疡及COPD呈正相关(r=0.158,0.185,0.237,0.108,0.116,0.104,0.147,0.266;P<0.05),与体质量、BMI、腰围、MSpO_(2)、甘油三酯、肌酐、尿酸、MCHC、PLT及WBC呈负相关(r=-0.206,-0.210,-0.110,-0.263,-0.144,-0.166,-0.175,-0.205,-0.211,-0.100;P<0.05)。logistic回归分析示,BMI、吸烟史、饮酒史、收缩压、MSpO2及肌酐是老年OSAHS相关高血压患者CAS的独立影响因素(OR=0.811,3.243,3.271,1.020,0.810,0.978;P<0.05)。结论老年OSAHS相关高血压患者CAS患病率较高,主要集中于70~80岁,且女性高于男性。吸烟史、饮酒史及收缩压是老年OSAHS相关高血压患者CAS的独立危险因素,BMI、MSpO2及肌酐浓度是其独立保护因素。
Objective To investigate the occurrence and influencing factors of carotid atherosclerosis(CAS)in the elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS)-related hypertension.Methods A total of 1290 consecutive elderly patients(≥60 years old)with polysomnography-diagnosed OSAHS admitted from January 2015 to October 2017 were enrolled in this multi-center study.After exclusion of secondary hypertension caused by diabetes,other causes and serious cardiovascular and cerebrovascular diseases(such as atrial fibrillation,heart failure and stroke),755 elderly OSAHS patients were finally included.According to whether they met the OSAHS related hypertension diagnostic criteria formulated by the Chinese Medical Doctor Association in 2012,they were divided into hypertension group(n=415)and non-hypertension group(n=340).Based on the occurrence of CAS or not,those patients were further assigned into CAS subgroup(n=74)and non-CAS subgroup(n=341).The demographic characteristics,sleep parameters,blood biochemical and blood routine indexes and medical history were compared between the 2 groups.SPSS statistics 20.0 was used for data analysis.Spearman correlation analysis and logistic regression analysis were employed to explore the influencing factors for CAS in elderly patients with OSAHS-related hypertension.Results The incidence of CAS was significantly higher in elderly OSAHS-related hypertension patients than the non-hypertension group[17.8%(74/415)vs 12.1%(41/340);P<0.05],the incidence was also higher in the female OSAHS-related hypertension patients than the male ones[21.0%(34/162)vs 15.8%(40/253);P<0.05],and the prevalence was mainly concentrated in the patients aged 70~80 years,followed by those of 60~70 and≥80 years old[29.7%(30/101)vs 13.9%(41/296)and 16.7%(3/18);P<0.05].Age,body mass,body mass index(BMI),waist circumference,smoking history,drinking history,systolic blood pressure,total sleep time(TST),mean pulse oxygen saturation(MSpO2),triglyceride,creatinine,uric acid,mean corpuscular hemoglobin concentration(MCHC),platelet count(PLT),white blood cell count(WBC),peptic ulcer and chronic obstructive pulmonary disease(COPD)differed between the CAS subgroup and non-CAS subgroup(all P<0.05).Spearman correlation analysis showed that age,smoking history,drinking history,systolic blood pressure,TST,gastroesophageal reflux disease,peptic ulcer and COPD were positively correlated with CAS in elderly patients with OSAHS-related hypertension(r=0.158,0.185,0.237,0.108,0.116,0.104,0.147,0.266;P<0.05),while,body weight,BMI,waist circumference,MSpO_(2),triglycerides,creatinine,uric acid,MCHC,PLT and WBC were negatively correlated(r=-0.206,-0.210,-0.110,-0.263,-0.144,-0.166,-0.175,-0.205,-0.211,-0.100;P<0.05).Logistic regression analysis indicated that BMI,smoking history,drinking history,systolic blood pressure,MSpO2 and creatinine were independent influencing factors of CAS in elderly patients with OSAHS related hypertension(OR=0.811,3.243,3.271,1.020,0.810,0.978;P<0.05).Conclusion The elderly patients with OSAHS-related hypertension have generally high prevalence of CAS,and it is more common in those aged 70-80 years and in women than men.Smoking history,drinking history and systolic blood pressure are independent risk factors for CAS,while BMI,MSpO2 and creatinine concentration are independent protective factors in the population.