南方医院睡眠中心及心内科住院病人阻塞性睡眠呼吸暂停低通气综合征流行病学调查及其与心血管病关系研究

发布时间：2018-05-19 07:31

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 心血管疾病　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景和目的OSAHS是常见的睡眠呼吸疾病,可引全身多系统并发症,心血管系统尤甚,其患病率在人群中日趋增长,严重危害人类身体健康。本研究通过分析南方医院睡眠中心及心内科OSAHS的流行病学特点及其与心血管病的关系,加强对该病的认识,并为日后的临床筛查诊治工作提供参考价值。研究对象和方法(1)收集南方医院呼吸睡眠中心2013.01.01至2015.12.31所有完成多导睡眠监测且年龄≥18周岁的住院患者完整病例资料。根据呼吸暂停低通气指数(AHI)分为OSAHS组及非OSAHS组两组,采用病例对照方法比较两组的临床特点,多因素Logistic回归法分析OSAHS发生的可能危险因素。(2)收集南方医院心血管内科(包括CCU)同一时间段所有出院诊断为OSAHS的住院患者完整临床资料,与呼吸睡眠中心OSAHS患者比较。统计心血管内科确诊OSAHS患者的五种心血管疾病患病率,与呼吸睡眠中心及文献数据比较。统计心血管内科同一时间段内五种心血管疾病中OSAHS的患病率,五种疾病间比较。(3)根据AHI值将两科确诊OSAHS患者分别分为轻中重度三组,比较三组间各系统合并症患病率。结果(1)呼吸睡眠中心三年间完善PSG的不重复住院人数1668人,确诊OSAHS 775例,OSAHS患病率为46.5%;心血管内科三年间不重复住院患者人数10389人,确诊OSAHS 204例,OSAHS诊断率为1.9%,其中男性患者(2.8%)约为女性(0.7%)的4倍。(2)呼吸睡眠中心部分共纳入925例患者:OSAHS组775例[男689(88.9%),女 86(11.1%)],年龄 45.9±11.8 岁;非 OSAHS 组 150 例[男 96(64.0%),女54(36.0%)],年龄47.4±13.3岁。OSAHS组患者BMI、男性比例、打鼾、日间困倦、腹型肥胖、颈短粗、咽腔狭窄比例高于非OSAHS组(P0.05);平均年龄、吸烟及饮酒史无统计学差异。Logistic回归分析得出OSAHS发生的独立危险因素有:BMI、男性性别及咽腔狭窄(P0.05),而与BMI相关的腹型肥胖、颈短粗并非OSAHS独立危险因素。OSAHS组高血压、血红蛋白升高、高脂血症、糖尿病及糖耐量减低患病率较非OSAHS组高,哮喘、焦虑或抑郁患病率较非OSAHS组低(P0.05);两组患者空腹血糖受损、脑梗塞、脑出血、慢性阻塞性肺疾病、慢性肾功能不全及胃食管返流的患病率无统计学差异。(3)文献报道OSAHS患者中高血压、冠心病、心律失常、心力衰竭、肺动脉高压的患病率分别为50%,30%,50%,10%,17%;心血管内科OSAHS患者五种疾病患病率分别为79.4%,20.9%,21.6%,12.3%,1.0%,其中高血压患病率较文献数据偏高,心律失常及肺动脉高压偏低,其余相差不大;呼吸睡眠中心OSAHS患者五种疾病患病率分别为40.4%,2.5%,5.8%,0.3%,0.1%,比心血管内科及文献数据均偏低。心血管内科三年间五种疾病中OSAHS的患病率分别为2.9%,1.1%,0.7%,0.9%及0.8%,高血压患者中OSAHS患病率最高。(4)呼吸睡眠中心OSAHS患者轻中重度三组间比较,随着严重度增加,高脂血症患病率呈递增趋势,焦虑或抑郁患病率递减,其余合并症患病率三组间无统计学差异;心血管内科OSAHS患者三组间合并症患病率均无统计学差异。结论(1)心血管内科OSAHS诊断率为1.9%,较文献报道的20%人群患病率明显偏低,提示心血管内科对于OSAHS的筛查诊断存在不足。(2)BMI、男性、咽腔狭窄作为OSAHS发生的独立危险因素,应注意对其重点筛查。临床应以腹围、颈围等具体量化指标代替主观查体描述。OSAHS男女患病率比例为4:1,较人群研究数据(2-3:1)高,临床应放宽对女性的筛查标准。(3)呼吸睡眠中心对OSAHS的五种心血管合并症筛查力度有待提高;心血管内科应加强对心律失常及肺动脉高压患者OSAHS的筛查。(4)OSAHS也可导致高脂血症、糖代谢异常、血红蛋白升高、转氨酶升高等情况的发生率增高。临床对于OSAHS患者是否合并糖代谢异常的判断应以糖耐量试验为标准,糖化血红蛋白仅作参考。(5)临床评估OSAHS严重程度及合并症发生风险时,除了以AHI值为参考外,应同时关注低氧血症程度等指标。
[Abstract]:Background and objective OSAHS is a common sleep respiratory disease, which can lead to systemic multiple system complications, especially in the cardiovascular system. The prevalence rate is increasing in the population and seriously endangers the human health. This study analyzed the characteristics of the flow disease and the relationship with cardiovascular disease in the sleep center of the southern hospital and the Department of Cardiology in the Department of Cardiology, and strengthened the relationship with cardiovascular disease. Understanding of the disease and providing reference value for the future clinical screening and diagnosis and treatment. Research objects and methods (1) all cases of complete cases of hospitalized patients who have completed polysomnography from 2013.01.01 to 2015.12.31 and aged over 18 years of age in the respiratory and sleep center of the southern hospital are collected and divided into group OSAHS according to the apnea hypopnea index (AHI). Non OSAHS group two groups, using case control method to compare the clinical characteristics of the two groups, multiple factor Logistic regression analysis of the possible risk factors for the occurrence of OSAHS. (2) collect the complete clinical data of all hospitalized patients with OSAHS in the same time period of the cardiovascular department of the southern hospital (including CCU), and compare with the OSAHS patients in the respiratory sleep center. The prevalence rate of five cardiovascular diseases in OSAHS patients with cardiovascular medicine was compared with the respiratory sleep center and the literature data. The prevalence of OSAHS in the five cardiovascular diseases in the same period of cardiovascular medicine and the comparison between five diseases were compared. (3) the two families of OSAHS patients were divided into three groups of moderate and severe cases according to the value of AHI, and three groups were compared. Results (1) the number of non repeated hospitalization of PSG in the three years of the respiratory sleep center was 1668, 775 cases were confirmed, the prevalence rate of OSAHS was 46.5%, 10389 in the three years of cardiovascular medicine, 204 cases of confirmed OSAHS, and 1.9% in OSAHS diagnosis, of which the male patients (2.8%) were about 4 (0.7%) 4 (2.8%). (2) 925 patients were included in the respiratory and sleep center part: 775 cases in group OSAHS [male 689 (88.9%), 86 (11.1%)], age 45.9 + 11.8, 150 cases (96 (64%) and 54 (36%)) in non OSAHS group, male proportion, snoring, daytime sleepiness, abdominal obesity, short neck, and stricture of the throat were higher than those in non OSAHS group. P0.05); average age, no statistical difference in smoking and drinking history,.Logistic regression analysis showed that the independent risk factors for OSAHS were BMI, male sex and stenosis of the pharynx (P0.05), and BMI related abdominal obesity, and neck short thickness was not the OSAHS independent risk factor.OSAHS group hypertension, hemoglobin elevation, hyperlipidemia, diabetes and glucose tolerance The incidence of reduced morbidity was higher than that in the non OSAHS group, and the prevalence of asthma, anxiety or depression was lower than that in the non OSAHS group (P0.05); there was no statistical difference between the two groups of patients with impaired fasting blood glucose, cerebral infarction, cerebral hemorrhage, chronic obstructive pulmonary disease, chronic renal insufficiency and gastroesophageal reflux. (3) the literature reports of hypertension, coronary heart disease, and arrhythmia in OSAHS patients. The prevalence of heart failure and pulmonary hypertension was 50%, 30%, 50%, 10%, 17%. The prevalence rates of five diseases in OSAHS patients were 79.4%, 20.9%, 21.6%, 12.3%, 1%, respectively, among which the prevalence of hypertension was higher than that in the literature, arrhythmia and pulmonary hypertension were low, and the rest of the disease was not significant; five diseases in the respiratory and sleep center OSAHS patients. The prevalence rate was 40.4%, 2.5%, 5.8%, 0.3%, 0.1%, compared with cardiovascular medicine and literature. The prevalence rate of OSAHS was 2.9%, 1.1%, 0.7%, 0.9% and 0.8% in five kinds of diseases in the cardiovascular medicine department for three years. (4) the patients with OSAHS in the respiratory and sleep center were compared with the moderate and severe groups, with the increase of severity. The prevalence rate of hyperlipidemia was increasing, the incidence of anxiety or depression decreased, and there was no statistical difference between the three groups of the other complications. There was no statistical difference between the three groups of OSAHS patients in cardiovascular medicine. Conclusion (1) the diagnostic rate of OSAHS in the cardiovascular medicine department was 1.9%, which was significantly lower than that of the reported 20% people. There are shortcomings in the screening and diagnosis of OSAHS in the cardiovascular medicine department. (2) BMI, male, as an independent risk factor for the occurrence of OSAHS, the stenosis of the pharynx should be considered as an independent risk factor for the occurrence of OSAHS. The specific quantitative indicators of abdominal circumference and neck circumference should be used instead of subjective examination to describe the prevalence rate of.OSAHS between men and women as 4:1, higher than the population study data (2-3:1) and clinical relaxation. Screening criteria for women. (3) screening of five types of cardiovascular complications in OSAHS should be enhanced by the respiratory sleep center; the cardiovascular department should strengthen the screening of OSAHS in patients with arrhythmia and pulmonary hypertension. (4) OSAHS may also lead to hyperlipidemia, abnormal glucose metabolism, elevated serum erythrocyte, and an increase in the incidence of aminotransferase and high levels of transaminase. The judgment of OSAHS patients with abnormal glucose metabolism should be based on glucose tolerance test and glycosylated hemoglobin as a reference. (5) when evaluating the severity of OSAHS and the risk of complication, the standard of hypoxemia should be paid attention to at the same time except for the reference of AHI.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766

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