阻塞性睡眠呼吸暂停综合征与血压、左心结构及左心功能不全关系的研究

发布时间：2018-03-28 02:10

本文选题：睡眠呼吸暂停　切入点：阻塞性　出处：《昆明医学院》2011年硕士论文

【摘要】：目的：探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)与血压、左心结构及左心功能不全的相关性,为预防和治疗高血压、心功能不全提供新的思路。方法：选取昆明医学院第一附属医院心内科、干疗科2009年6月至2010年12月期间以睡眠时打鼾、反复憋醒伴日间嗜睡等为主诉的患者共68例为研究对象。对所有患者进行多导睡眠图(PSG)监测。据呼吸暂停-低通气指数(AHI)将入选患者分为三组：轻度OSAS组(AHI：5～20次/h)、中度OSAS组(AHI：21～40次/h)、重度OSAS组(AHI40次/h)。对入选对象行超声心动图检查测定入选患者的心脏结构和功能指标。比较不同程度OSAS组之间在血压、心脏结构和功能指标上的差异,并对OSAS与心脏结构和功能的相关性进行分析研究。结果：共有68例患者入选,其中男性55例(80.88%),女性13例(19.12%),年龄(53-79)岁,平均年龄(63.65±7.34)岁。三组在性别、年龄、腰臀比(WHR)、颈围(NC)、体重质量指数(BMI)指标上比较差别无统计学意义(P0.05),但是,三组在高血压发生率(分别为：40.00%,69.57%,83.33%)的比较上差异有显著性(P0.01)；三组之间两两比较,血压的水平以中、重度OSAS组升高明显。心脏结构指标中,轻、中、重度OSAS在舒张期室间隔厚度(IVST)(分别为：9.88±1.07mm,10.14±0.99mm,12.49±0.91mm)、左心室后壁厚度(LVPWT)(9.77±0.70mm,10.52±0.62mm,12.93±1.03mm)、左心室肌重量(LVM)(分别为：225.69±34.54g,256.45±32.23g,289.45±46.33g)、左心室肌重量指数(LVMI)(分别为：124.73±20.86g/m2,142.79±19.70g/m2,150.96±27.17g/m2)等指标上,三组比较差异显著(P0.01)；以LVMI为衡量左心室肥厚(LVH)的指标,结果显示：不同程度OSAS之间LVH的发生率分别为：33.33%,52.17%,63.34%,差异有显著性(P=0.021)；三组之间两两比较,以中、重度OSAS组LVH较重；相关性分析显示LVMI与AHI呈高度正相关关系(r=0.79)。心脏舒张功能指标中,轻、中、重度OSAS在左室舒张早期最大流速与舒张晚期最大流速之比(E/A)值(分别为：1.37±0.08,0.72±0.10,0.70±0.13)的比较上差异具有统计学意义(P=0.020)；不同程度OSAS之间E/A1的发生率分别为20.00%,43.48%,53.33%,三组比较差异显著(P=0.042)；三组之间两两比较,中、重度OSAS组E/A值远低于正常范围；相关性分析显示E/A值与AHI呈中度负相关关系(r=—0.693)。心脏收缩功能指标中,轻、中、重度OSAS在左心室射血分数(LVEF)(分别为：62.82%±4.47%,61.55%±5.12%,61.37%±5.72%),左心室短轴缩短率(LVFS)(分别为：36.31%±3.13%,33.72%±4.40%,33.57%±4.71%)指标的比较上差异无统计学意义。结论：随着OSAS病情程度的加重,高血压、左心室肥厚、左心室舒张功能不全的发生率及严重程度均加重；左心室肥厚、左心室舒张功能不全与反应缺氧的综合指标AHI成正相关关系；积极干预治疗OSAS可以更有效地控制血压,延缓心脏重塑的发生和发展,改善心功能。
[Abstract]:Objective: to investigate the relationship between obstructive sleep apnea syndrome (OSAs) and blood pressure, left ventricular structure and left ventricular dysfunction, and to provide a new idea for the prevention and treatment of hypertension and cardiac insufficiency. Methods: from June 2009 to December 2010, Department of Cardiology, first affiliated Hospital of Kunming Medical College, snored during sleep. A total of 68 patients, including repeated suffocating awake with daytime sleepiness, were studied. Polysomnography (PSG) was performed on all patients. According to apnea hypopnea index (AHII), the patients were divided into three groups: mild OSAS group: AHI: AHI: 20 times. The heart structure and function were measured by echocardiography in moderate OSAS group and severe OSAS group respectively. The blood pressure was compared between different OSAS groups. The relationship between OSAS and cardiac structure and function was analyzed. Results: a total of 68 patients were enrolled in this study, including 55 males (80.88g) and 13 females (aged 53-79), with an average age of 63.65 卤7.34 years. There was no significant difference in sex, age, waist-to-hip ratio (WHRR), neck circumference (NCN), body mass index (BMI) between the three groups (P 0.05), however, there was no significant difference among the three groups in terms of sex, age, waist to hip ratio (WHR) and hip to hip ratio (WHR). There were significant differences in the incidence of hypertension among the three groups (69.57 and 83.33, respectively). The blood pressure levels in moderate and moderate OSAS groups were significantly higher than those in the other two groups. The mean diastolic septal thickness (OSAS) was 10.14 卤0.99mm (10.14 卤0.99mm), the posterior wall thickness of left ventricle (9.77 卤0.70mm) 10.52 卤0.62mm (12.93 卤1.03mm), the weight of left ventricular muscle (= 225.69 卤34.54g / 256.45 卤32.236.45 卤46.33g / g), the left ventricular mass index (LVMI) were 124.73 卤20.86g/m2142.79 卤19.70g/m2150.96 卤27.17gm2, respectively. The results showed that the incidence of LVH in different degree of OSAS was 33.33 and 52.17, the difference was significant (P0.021), the comparison between the three groups was more serious, especially in moderate and severe OSAS groups, and the incidence of LVH in different degree of OSAS was 52.17% and 63.34% (P < 0.01), respectively, and the difference was significant (P 0.021), especially in the moderate and severe OSAS groups, the incidence of LVH was higher in the moderate and severe OSAS groups than in the other two groups, and there was no significant difference among the three groups. Correlation analysis showed that there was a high positive correlation between LVMI and AHI. The ratio of E / A of severe OSAS to that of late diastolic velocity (1: 1.37 卤0.08 卤0.72 卤0.10 卤0.70 卤0.13, respectively) was significantly different, and the incidence of E/A1 among different degrees of OSAS was 20.00% 43.4853.33, respectively. The difference was significant among the three groups. The three groups were compared in two and two. The E / A value of moderate and severe OSAS group was significantly lower than that of normal range, and the correlation analysis showed that there was a moderate negative correlation between E / A value and AHI. There was no significant difference in the left ventricular ejection fraction (% 62.82% 卤4.47, 61.55% 卤5.1222% 卤5.72%) and the shortening rate of left ventricular short axis (36.31% 卤3.13% 卤33.72% 卤4.71%, respectively). Conclusion: with the exacerbation of OSAS, the incidence and severity of hypertension, left ventricular hypertrophy, left ventricular diastolic insufficiency, left ventricular hypertrophy, There was a positive correlation between left ventricular diastolic dysfunction and AHI, a comprehensive index of response to hypoxia, and active intervention in the treatment of OSAS could more effectively control blood pressure, delay the occurrence and development of cardiac remodeling, and improve cardiac function.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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