摘要
目的评估老年阻塞性睡眠呼吸暂停(OSA)患者的睡眠觉醒、动态血压和新发心力衰竭(NOHF)的关系。方法前瞻性连续性选取2015年3月至2019年3月在我院诊治的584例老年OSA患者,年龄为(70.1±7.2)岁。在基线时获得多导睡眠图监测(PSG)结果,并计算觉醒指数(AI),根据四分位数分为4组,AI低水平组(AI<18.4次/h,186例)、中低水平组(18.4~29.1次/h,177例)、中高水平组(29.2~41.2次/h,137例)和高水平组(>41.2次/h,84例),随访18个月,比较4组的动态血压,并分析AI与NOHF风险的关系。结果与低水平组比较,中低、中高和高水平组患者的年龄更大(70.1岁、70.3岁、73.3岁比68.7岁,F=2.726,P=0.043),吸烟更多(43.8%、49.6%、54.8%比38.2%,χ^(2)=8.809,P=0.032),体质指数大(26.3、26.7、27.6比25.4 kg/m^(2),F=2.731,P=0.042),Epworth嗜睡量表评分(ESS)(7.83、8.50、9.91比7.64,F=5.124,P=0.018)和睡眠低通气指数(AHI)更高(23.5、34.8、52.7比17.6,F=5.632,P=0.007)更高,夜间氧饱和度更低(80.2、75.3、72.1比83.7 mmHg,F=4.811,P=0.024),N末端B型利钠肽原(NT-proBNP)水平更高(317.5、337.5、359.2比267.5 pg/L,F=4.307,P=0.033)。中位随访18个月(14~24个月),动态血压监测结果显示,中低、中高和高水平组的24 h平均收缩压(147.3、148.6、156.2比143.8 mmHg,F=5.4311,P=0.013)、24 h平均舒张压(80.1、79.5、83.7比76.5 mmHg,F=5.679,P=0.011)等均高于低水平组患者。生存分析结果显示,共有75例(12.8%)NOHF,多为射血分数保留(47例)或中间值(20例)HF,低、中低、中高和高水平组的NOHF率分别为6.5%、12.4%、16.1%和22.4%,中低、中高和高水平组的NOHF风险高于低水平组(log-rankχ^(2)=11.624,P=0.007)。将单因素分析中P<0.2的变量和年龄、性别等纳入多因素Cox回归分析,结果发现,年龄(HR=1.724,95%CI:1.216~3.135)、糖尿病(HR=1.514,95%CI:1.127~3.058)、NT-proBNP(HR=1.517,95%CI:1.232~2.366)、夜间舒张压(HR=2.004,95%CI:1.332~4.638)和中高AI水平(HR=1.611,95%CI:1.204~2.967)或高AI水平(HR=1.863,95%CI:1.272~3.538)是老年OSA患者NOHF的独立相关因素。结论老年OSA患者的睡眠觉醒会增加动态血压水平和NOHF风险。
Objective To evaluate the relationship between sleep arousal,ambulatory blood pressure and new-onset heart failure(NOHF)in elderly patients with obstructive sleep apnea(OSA).Methods A total of 584 elderly patients with OSA who were diagnosed and treated in our hospital between March 2015 and March 2019 were prospectively and consecutively selected,with a mean age of(70.1±7.2)years.Polysomnography(PSG)results were obtained at baseline,and the arousal index(AI)was calculated.Based on the quartiles of AI,patients were divided into 4 groups:a low-level group(AI<18.4/h,186 cases),a low-medium level group(18.4-29.1/h,177 cases),a medium-high level group(29.2-41.2/h,137 cases)and a high-level group(>41.2/h,84 cases).Participants were followed up for 18 months,the results of ambulatory blood pressure were recorded and compared,and the relationship between AI and the risk of NOHF was analyzed.Results Compared with the low-level group,patients in the low-medium,medium-high,and high-level groups were older(70.1,70.3,73.3 vs.68.7 years,F=2.726,P=0.043)and had more smokers(43.8%,49.6%,54.8%vs.38.2%,χ^(2)=8.809,P=0.032),a larger body mass index(26.3,26.7,27.6 vs.25.4 kg/m^(2),F=2.731,P=0.042),a higher Epworth sleepiness scale score(7.83,8.50,9.91 vs.7.64,F=5.124,P=0.018),a higher apnea hypopnea index(23.5,34.8,52.7 vs.17.6,F=5.632,P=0.007),lower nocturnal oxygen saturation(80.2,75.3,72.1 vs.83.7 mmHg,F=4.811,P=0.024),and higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(317.5,337.5,359.2 vs.267.5 pg/L,F=4.307,P=0.033).At the median follow-up(18 months,14-24 months),the results of ambulatory blood pressure monitoring showed that 24-hour systolic blood pressure(24 h SBP)(147.3,148.6,156.2 vs.143.8 mmHg,F=5.4311,P=0.013),24-hour diastolic blood pressure(24 h DBP)(80.1,79.5,83.7 vs.76.5 mmHg,F=5.679,P=0.011)in the low-medium,medium-high and high-level groups were higher than those in the low-level group.The results of survival analysis showed that there were 75(12.8%)cases of NOHF,mostly with preserved ejection fraction(47 cases)or mid-range ejection fraction heart failure(20 cases).The incidences of NOHF were 6.5%,12.4%,16.1%and 22.4%,respectively for the low level,low-medium,medium-high and high-level groups,and the risk of NOHF in the low-medium,medium-high and high-level groups was significantly higher than in the low level group(log-rankχ^(2)=11.624,P=0.007).Variables with P<0.2 in the univariate analysis,age and sex were included in the multivariate Cox regression analysis.The results showed that age(HR=1.724,95%CI:1.216-3.135),diabetes(HR=1.514,95%CI:1.127-3.058),NT proBNP(HR=1.517,95%CI:1.232-2.366),nocturnal diastolic blood pressure(HR=2.004,95%CI:1.332-4.638),and middle-high AI level(HR=1.611,95%CI:1.204-2.967)and high AI level(HR=1.863,95%CI:1.272-3.538)were independent factors of NOHF in elderly OSA patients.Conclusions Sleep arousal in elderly patients with OSA increases blood pressure levels and the risk of NOHF.
作者
李曼
高辉
王志建
孟华
白智峰
Li Man;Gao Hui;Wang Zhijian;Meng Hua;Bai Zhifeng(Department of Cardiology,the First People's Hospital of Shangqiu,Shangqiu 476100,China;Department of Cardiology,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450000,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2023年第5期525-530,共6页
Chinese Journal of Geriatrics
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210988)。
关键词
阻塞性睡眠呼吸暂停
睡眠觉醒
动态血压
心力衰竭
Obstructive sleep apnea
Sleep arousal
Ambulatory blood pressure
Heart failure
