阻塞性睡眠呼吸暂停低通气综合征（OSAHS）相关性高血压影响因素分析

发布时间：2018-04-11 22:23

  本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 高血压　； 参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-Hypopnea syndrome,OSAHS)是睡眠呼吸障碍有关的国际公共卫生问题之一,是多种因素导致的上气道反复堵塞引起节律性呼吸暂停和低通气,与OSAHS相关联的高血压称为阻塞性睡眠呼吸暂停相关性高血压。随着社会的发展和医学技术的进步,人们对生活质量的要求进一步提高,OSAHS的诊断和治疗受到重视。在我国OSAHS越来越普遍,发病率不断升高,成年人中OSAHS发病率在2%~4%,可引发全身多种多系统疾病,因低氧血症引发脑缺氧,患者往往具有白天嗜睡、乏力、精神差、注意力难集中等症状,加之其他心、脑、肾、内分泌疾病,患者生活质量和生命安全受到严重威胁,工作效率下降,高空、驾驶多发事故,安全生产受到影响。高血压在世界范围内都是一种比较常见的疾病,相关数据统计,世界各国发病率均高达10%~20%,高血压对人们健康的威胁非常大,带给患者的心理压力影响了他们的生活质量。而当今社会越来越多的人过着不健康的生活方式,加上巨大的就业压力,导致高血压人群的数量居高不下,高血压一旦病发十分凶险,甚至会引起心脑肾血管疾病等,对高血压相关疾病的预防和治疗,深受广大民众的关注。有学者指出,OSAHS是继发性高血压病因之首,两种病症之间存在着很大的联系。越来越多的医学界专家投入到相关研究中,目前的研究成果来看,持续气道正压通气是常见的治疗方式,也经常在临床治疗中使用,治疗效果好。虽然如此,有关OSAHS相关性高血压的影响因素研究成果却并不多,缺乏权威性的研究结论,还需要进一步加强和深入研究。本研究对OSAHS相关性高血压的多种影响因素进行观察分析,探讨OSAHS是否为高血压的独立危险因素,明确相关影响因素,为OSAHS相关性高血压的早期诊断和防治提供参考依据。对象与方法回顾性分析郑州大学人民医院(河南省人民医院)2015年3月-2016年12月期间前来就诊的150例OSAHS患者,均经多导睡眠监测确诊,制作问卷调查表,记录患者姓名、性别、年龄、职业、体质指数(BMI)、颈围、腰围、吸烟史、饮酒史、日间嗜睡状况、相关体征及SBP、DBP情况等一般信息资料,及多导睡眠监测、血氧饱和度等检查结果,根据2012年《阻塞性睡眠呼吸暂停相关性高血压临床诊断和治疗专家共识》,患者最终被分为两组:OSAHS相关性高血压组和非高血压组,并对OSAHS相关性高血压的多种影响因素进行回归分析,得出结论。采用SPSS 15.0软件进行统计学处理,计量资料以均数±标准差(±s)表示,两组间比较采用重复测量数据方差分析及t检验,定性资料以率(%)表示,两组间比较采用卡方检验,以高血压为结局变量进行多自变量Logistic回归分析,P0.05为差异有统计学意义。结果经过对以上研究整理,可以看到,两组患者吸烟、白天嗜睡、家族性高血压病史、下颌后缩、腭垂过长(过宽)、体重、BMI、颈围、腰围差异有统计学意义;两组患者睡眠监测结果中AHI(χ2=2.342,P=0.032)、LSaO2(χ2=-2.627,P=0.012)、MSaO2(χ2=-2.108,P=0.043)、CT90%(χ2=2.426,P=0.031)、ODI(χ2=2.107,P=0.039)、微觉醒指数(χ2=2.074,P=0.023)、总呼吸暂停时间(χ2=2.272,P=0.025)、最长呼吸暂停时间(χ2=2.437,P=0.024)的差异具有统计学意义,结果显示,低氧和呼吸暂停的程度与高血压发病有关。以患者高血压为因变量,以吸烟史、白天嗜睡、家族性高血压病史、下颌后缩、腭垂过长(过宽)、体重、BMI、颈围、腰围、AHI、LSaO2、MSaO2、CT90%、ODI、微觉醒指数、总呼吸暂停时间、最长呼吸暂停时间为自变量进行多因素logistic回归分析,结果P值分别为0.016、0.009、0.011、0.037,OR值分别为3.216、1.147、5.618、1.075,提示吸烟史、BMI、白天嗜睡和最长呼吸暂停时间是OSAHS相关性高血压的独立危险因素。结论通过本研究进一步证实,OSAHS相关性高血压具有较高的发病率,与性别、烟酒史、下颌、舌体、腭垂的结构、肥胖与否及程度、缺氧程度、觉醒次数有密切关系,男性、长期过度吸烟饮酒、上呼吸道塌陷阻塞、肥胖、缺氧等是OSAHS相关性高血压的发病因素,其中吸烟、BMI、嗜睡、最长呼吸暂停时间是OSAHS相关性高血压的独立危险因素。
[Abstract]:Background and objective: obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea-Hypopnea syndrome, OSAHS) is one of the international public health issues related to sleep apnea, the upper airway is caused by many factors caused by blockage of rhythmic repeated apnea and hypopnea associated hypertension and OSAHS, known as the relationship between obstructive sleep apnea hypertension. With the development of society and the progress of medical technology, people need to further improve the quality of life, pay attention to the diagnosis and treatment of OSAHS. OSAHS is more and more common in our country, the incidence is rising, the adults in the incidence of OSAHS in 2%~4%, can cause systemic multi system disease, hypoxemia caused by cerebral hypoxia patients often have, daytime sleepiness, fatigue, poor spirit, difficulty concentrating and other symptoms such as heart, brain, kidney, endocrine disease, patients with life The quality of life and a serious threat to the safety, decreased work efficiency, high altitude, driving accident, safety production is affected. Hypertension is a common disease in the world, the relevant statistical data, the world incidence rate is as high as 10%~20%, hypertension is very large for people's health threat to the patient's psychological pressure affects their quality of life. But nowadays more and more people live a healthy lifestyle, coupled with the huge employment pressure, resulting in the number of hypertension is high in hypertension, once the disease is very dangerous, even can cause cardiovascular and renal vascular disease, prevention and treatment of hypertension related diseases, the majority of the public's attention. Some scholars have pointed out that OSAHS is the first cause of secondary hypertension, there is a great relationship between the two diseases. More and more medical experts into phase In the research, the results of the current study, CPAP is the common treatment methods are often used in clinical treatment, the treatment effect is good. However, research results about the effect of OSAHS related factors of hypertension are not many, the lack of authoritative research results, also need to further strengthen and further study the study on the influence of multi factors. OSAHS related hypertension were observed and analyzed to investigate whether OSAHS is an independent risk factor of hypertension, clear related factors, and provide reference for early diagnosis and treatment of OSAHS induced hypertension. The object and method of analysis of Zhengzhou University people's Hospital (Henan Province People's Hospital) reviewed 150 cases of OSAHS patients during the March 2015 -2016 year in December come to see the doctor, were diagnosed by polysomnography monitoring, making questionnaire, record the patient's name, gender, age, occupation, body Quality index (BMI), neck circumference, waist circumference, smoking history, drinking history, daytime sleepiness, signs and related SBP, DBP and other general information, and polysomnography, oxygen saturation and other examination results, according to the 2012 "obstructive sleep apnea related hypertension diagnosis and treatment expert consensus" patients the final was divided into two groups: OSAHS correlation between hypertension group and non hypertension group, and a variety of effects on OSAHS related factors of hypertension by regression analysis. The conclusion was analyzed by SPSS 15 software, the measurement data to mean + standard deviation (+ s) said that the two groups were compared using ANOVA and t test the repeated measurement data, using qualitative data rate (%), two groups were compared by chi square test, multiple regression analysis with hypertension as the independent variable Logistic outcome variables, P0.05 difference was statistically significant. Results after the 涓婄爺绌舵暣鐞，

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