CAJ | 학술논문

目的回顾性分析老年阻塞性睡眠呼吸暂停综合征(OSAS)患者的血管内皮功能和心脑血管事件的相关性及对预后的影响. 方法 OSAS患者79例(OSAS组),老年OSAS组和非老年OSAS组分别为39例和40例;排除OSAS诊断的老年患者60例(老年非OSAS组).通过电话和门诊进行随访,随访时间中位数25个月.所有患者均接受:(1)彩色多普勒超声测定肱动脉血流介导的血管舒张功能(FMD);(2)检查和测定睡眠呼吸事件、血清生化指标;(3)随访心脑血管事件. 结果 (1)老年OSAS组FMD低于老年非OSAS组(P<0.05).(2)老年OSAS组体质指数高于老年非OSAS组(P<0.01),最低血氧饱和度、平均血氧饱和度低于老年非OSAS组(P<0.01,P<0.05).多因素Logistic回归分析结果显示,空腹血糖升高是FMD主要危险因素(OR=1.83,95%CI:1.11～3.03),其次是最低血氧饱和度(OR=0.92,95% CI:0.85～1.00).(3)老年OSAS组心脑血管事件发生率高于非老年OSAS组和老年非OSAS组(χ~2=7.339,P<0.05).多因素Logistic回归分析结果显示,FMD与患者预后密切相关(OR=1.33,95%CI:1.06～1.66),其次是超敏C反应蛋白(OR=0.51,95% CI:0.34～0.76). 结论老年OSAS患者血管内皮功能受损更为严重,心脑血管事件发生率增加.OSAS可能通过间歇低氧和炎性反应等多种机制损伤血管内皮功能,参与影响患者预后.
목적 회고성분석노년조새성수면호흡잠정종합정(OSAS)환자적혈관내피공능화심뇌혈관사건적상관성급대예후적영향. 방법 OSAS환자79례(OSAS조),노년OSAS조화비노년OSAS조분별위39례화40례;배제OSAS진단적노년환자60례(노년비OSAS조).통과전화화문진진행수방,수방시간중위수25개월.소유환자균접수:(1)채색다보륵초성측정굉동맥혈류개도적혈관서장공능(FMD);(2)검사화측정수면호흡사건、혈청생화지표;(3)수방심뇌혈관사건. 결과 (1)노년OSAS조FMD저우노년비OSAS조(P<0.05).(2)노년OSAS조체질지수고우노년비OSAS조(P<0.01),최저혈양포화도、평균혈양포화도저우노년비OSAS조(P<0.01,P<0.05).다인소Logistic회귀분석결과현시,공복혈당승고시FMD주요위험인소(OR=1.83,95%CI:1.11～3.03),기차시최저혈양포화도(OR=0.92,95% CI:0.85～1.00).(3)노년OSAS조심뇌혈관사건발생솔고우비노년OSAS조화노년비OSAS조(χ~2=7.339,P<0.05).다인소Logistic회귀분석결과현시,FMD여환자예후밀절상관(OR=1.33,95%CI:1.06～1.66),기차시초민C반응단백(OR=0.51,95% CI:0.34～0.76). 결론 노년OSAS환자혈관내피공능수손경위엄중,심뇌혈관사건발생솔증가.OSAS가능통과간헐저양화염성반응등다충궤제손상혈관내피공능,삼여영향환자예후.
Objective To retrospectively analyze the cardiovascular outcomes of the elderly patients with obstructive sleep apnea syndrome (OSAS) and the influence factors. Methods According to polysomnography examination, 79 OSAS patients and 60 patients without OSAS were selected and divided into 3 groups: elder OSAS group [39 patients older than 65 years, respiratory apnea index (AHI)≥5], non-elder OSAS group (40 patients less than 65 years old, AHI≥5) and elder control group (60 patients older than 65 years, AHK5). All patients were followed up by telephone and clinic consulting. The median follow-up duration was 25 months. All patients received the following studies: (1)Flow-mediated vasodilation (FMD), which was assessed by high-resolution ultrasound technique. (2)The sleep-related breathing events and serum biochemical indexes. (3)The death due to cardiovascular disease (CVD), angina, myocardial infarction and stroke. Results (1) FMD was significantly lower in elder OSAS group than in elder control group (P<0. 01). (2)In elder OSAS group versus elder control group, BMI was significantly higher (P<0. 01), while both lowest pulse oxygen saturation (LSpO_2 ) and mean series pulse oximeter ( MeanSpO_2 ) were significantly lower (P< 0.01 and P<0. 05, respectively). Multiple logistic regression analysis showed that impaired fasting plasma glucose was the primary injury factor for FMD (OR=1. 83, 95% CI:1. 11～3.03), and LSpO_2 was the secondary injury factor (OR = 0.92, 95% CI: 0. 85～1. 00). (3) The incidence of cardiovascular events in the 3 groups: the incidence of cardiovascular events was significantly higher in elder OSAS group than in the other 2 groups (χ~2= 7. 339, P<0. 05). Multiple logistic regression analysis showed that FMD (OR=1. 33, 95% CI:1. 06～1. 66)and hs-CRP (OR = 0.51, 95% CI: 0. 34～0.76) were closely related with prognosis. Conclusions Compared with non-elder OSAS group and elder control group, vascular endothelial function impairment is more serious and the incidence of cardiovascular events is higher in elder OSAS group. So OSAS may influence the prognosis of the patients by injuring the vascular endothelial function.