南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (11): 1587-1592.doi: 10.12122/j.issn.1673-4254.2020.11.08

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无心血管合并症的老年阻塞性睡眠呼吸暂停综合征患者心功能变化及其影响因素分析

高莹卉，温永飞，钱小顺，赵力博，徐 虎，徐伟豪，孔晓萱，车贺宾，王亚斌，刘 霖   

  • 出版日期:2020-11-20 发布日期:2020-11-23

Cardiac functional alterations and its risk factors in elderly patients with obstructive sleep apnea syndrome free of cardiovascular disease

  • Online:2020-11-20 Published:2020-11-23

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摘要： 目的 评估心血管并发症出现前老年阻塞性睡眠呼吸暂停综合征（OSA）患者的心脏结构和功能改变及其影响因素。方法 入选82名无心血管疾病的老年OSA患者，根据睡眠呼吸暂停低通气指数（AHI）分为轻度组（AHI<15次/h）和中/重度组（AHI≥15次/h）。记录患者人口统计学资料及一般基础资料，PSG监测结束的当天早上空腹状态下抽取静脉血，检测血常规与生化指标。在整夜多导睡眠监测完成1周内完成超声心动图检查，分析两组间心脏结构、功能及血生化指标等的差异。结果 中重度OSA组患者血小板比积（0.22±0.08 vs 0.17±0.04，P=0.032）、血肌酐水平（70.94±27.88 vs 54.49±34.22，P=0.022）高于轻度OSA组。两组患者的左室射血分数、室间隔厚度、左室后壁厚度、左房内径、左室舒张末内径均无显著差别。两组二尖瓣舒张早期血流速度峰值（E）相似，但中重度OSA组的舒张晚期二尖瓣血流速度峰值（A）高于轻度OSA组（70.35±6.87 vs 64.09±8.31，P=0.0001)，其E/A比值显著低于轻度OSA组（0.98±0.06 vs 1.08±0.05，P=0.0001）。多元线性回归显示，E/A比值与AHI呈负相关（β=-0.645，P=0.0001）。结论 在没有高血压和任何其他心血管疾病的情况下，老年中重度OSA患者可出现心脏舒张功能受损，其程度与AHI正相关。

关键词: 阻塞性睡眠呼吸暂停, 心脏舒张功能, 老年人, 低通气指数

Abstract: Objective To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications. Methods Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI<15) and moderate to severe OSA group (AHI≥15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups. Results Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 vs 0.17±0.04, P=0.032) and serum creatinine level (70.94±27.88 vs 54.49±34.22 μmol/L, P=0.022). The left ventricular ejection fraction, interventricular septal thickness, left ventricular posterior wall thickness, left atrial diameter and left ventricular end-diastolic diameter were all similar between the two groups. With a similar early diastolic mitral flow velocity (E) between the two groups, the patients with moderate to severe OSA had a significantly higher late diastolic mitral flow velocity (A) (70.35±6.87 vs 64.09±8.31, P=0.0001) and a significantly lower E/A ratio (0.98±0.06 vs 1.08±0.05, P=0.0001) than the patients with mild OSA. Multiple linear regression showed that the E/A ratio was negatively correlated with AHI (β =- 0.645, P=0.0001). Conclusion Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.

Key words: obstructive sleep apnea, cardiac diastolic function, elderly, apnea-hypopnea index