阻塞性睡眠呼吸暂停低通气综合征患者间接胆红素和尿酸水平的变化

目的:检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者体内间接胆红素(I-BIL)与尿酸(UA)水平,探讨其对OSAHS患者易患心血管疾病的作用机制。方法:对OSAHS病人和健康对照组进行多导睡眠监测。次晨采空腹静脉血4ml,检测血清I-BIL和UA。结果:I-BIL水平正常对照组14.53±3.64μmol/L,轻度、中度、重度OSAHS组患者均低于正常对照组(P<0.05~0.01);UA水平正常对照组252.05±75.64μmol/L,轻度、中度、重度OSAHS组患者均高于正常对照组(P<0.05~0.01)。相关分析显示I-BIL与呼吸暂停低通气指数(AHI)呈负相关(r=-0.32,P<0.01),最低血氧饱和度(SaO2)与AHI呈负相关(r=-0.56,P<0.01),UA与AHI呈正相关(r=0.27,P<0.05)。结论:OSAHS患者体内I-BIL水平降低,UA水平升高可能是OSAHS患者易患高血压、冠心病等心血管疾病的机制之一。     

血清同型半胱氨酸水平在阻塞性睡眠呼吸暂停低通气综合征和冠心病患者中的变化及其作用

目的:观察血清同型半胱氨酸(Hcy)水平在阻塞性睡眠呼吸暂停低通气综合征(OSHAS)及冠心病(CHD)患者中的变化和作用。方法:收集临床确诊CHD、OSAHS、CHD+OSAHS患者各30例,分别为CHD组、OSAHS组和CHD+OSAHS组。平行检测各组血清Hcy水平及睡眠呼吸监测指标:呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(SaO2)及平均SaO2,比较各组Hcy水平的差异以及Hcy水平与睡眠呼吸监测指标的相关性。并与30例体检健康者(健康对照组)对比分析。结果:(1)血清Hcy水平:三病例组明显高于健康对照组(P0.01),CHD+OSAHS组明显高于CHD组和OSAHS组(P0.01),CHD组与OSAHS组比较,差异无统计学意义(P0.05)。(2)病例组血清Hcy水平与AHI呈正相关(r=0.64,P0.01),与夜间平均SaO2和夜间最低SaO2均呈负相关(r分别为-0.64、-0.65,P0.01)。结论:血清Hcy水平升高与OSAHS患者SaO2减低有关,可能有利于CHD的发生与发展。     

阻塞性睡眠呼吸暂停低通气综合症与高血压的相关研究

目的 分析伴有高血压的阻塞性睡眠呼吸暂停低通气综合症（oSAHS）的睡眠呼吸障碍特点，并探讨两者之间的关系。方法 对诊断为OSAHS患者中45例高血压和32倒非高血压患者进行基础情况和夜间缺氧程度、睡眠结构和干扰睡眠因素以及OSAHS患者中高血压的危险因素进行分析。结果 高血压组睡眠呼吸暂停低通气指数（AHI）高于非高血压痛组．体重指数（BMI）是引起两组间睡眠呼吸暂停低通气指数（AHI）差异的显著因素。两组间夜间平均Sa02和最低Sa02比较差异无显著性（p〈0．05），睡眠呼吸暂停低通气指数（AHI）是引起夜间缺氧的显著因素。OSAHS患者中高血压病的危险因素是AHI、年龄、BMI。结论 OSAHS伴有高血压的患者的睡眠呼吸障碍程度更重，而夜间低氧血症与高血压无关,但与睡眠呼吸障碍的严重程度有关。年龄、肥胖和睡眠呼吸障碍的严重程度是OSAHS患者中高血压的危险因素。     

高血压合并OSAHS患者治疗前后血清Hcy、CRP、氧饱和度及血压变化及其临床意义

目的分析高血压合并阻塞性呼吸暂停低通气综合征(OSAHS)患者治疗前后血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、氧饱和度及血压的变化及意义。方法选择医院收治的100例高血压患者,按是否合并OSAHS分为高血压组[n=46,呼吸暂停低通气指数(AHI)<5次/h]与合并组(n=54,AHI≥5次/h),均于治疗前后检测血清Hcy、CRP、血氧饱和度(SaO_2)水平,并检测动态血压变化,分析上述指标与高血压合并OSAHS病情变化的关系。结果合并组Hcy、CRP、AHI高于高血压组,最低SaO_2低于高血压组,其治疗后Hcy、CRP、AHI低于治疗前,SaO_2高于治疗前(P<0.05);合并组随OSAHS病情程度的提升,Hcy、CRP、AHI逐渐升高,最低SaO_2降低(P<0.05),各组治疗后Hcy、CRP、AHI水平均低于治疗前,最低SaO_2高于治疗前(P <0.05);高血压+轻度、中度、重度OSAHS组整体血压昼夜节律变化幅度高于高血压组(P<0. 05),治疗后,除高血压+轻度OSAHS组mSBP、mDBP外,各组血压较治疗前降低(P <0.05);高血压合并OSAHS患者Hcy、CRP与AHI、nSBP均呈正相关,与最低SaO_2呈负相关(P <0.05)。结论高血压合并OSAHS患者随OSAHS程度的上升,Hcy、CRP、AHI水平上升,最低SaO_2降低,且其Hcy、CRP的变化可影响患者通气功能及血压变化节律。     

阻塞性睡眠呼吸暂停低通气综合征外周血IGF-2及其mRNA水平变化的初步研究

目的： 观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者胰岛素样生长因子-2（IGF-2）水平的变化,并探讨其与OSAHS及其并发的心血管疾病的关系。方法： 选择40例OSAHS患者作为病例组，20例正常人为对照组，病例组再根据血压水平分为正常血压及高血压组，采用酶联免疫吸附试验( ELISA)检测外周血血清中IGF-2水平，用RT-PCR技术检测受试者外周血单个核细胞胰岛素样生长因子-2mRNA（IGF-2 mRNA）水平,并对病例组中15例呼吸暂停低通气指数（AHI）>40次/h的患者进行经鼻持续气道正压通气（nCPAP）治疗1月后,重复以上过程。结果： OSAHS患者血清IGF-2水平及外周血单个核细胞 IGF-2 mRNA水平明显高于对照组(P<0.05)，并与血压升高水平相关。进一步分析与患者AHI呈正相关，与小于90%血氧饱和度时间占总睡眠时间百分比呈正相关,与呼吸暂停时间占总睡眠时间百分比呈正相关，与平均血氧饱和度、最低血氧饱和度呈负相关。经nCPAP治疗后,重度OSAHS患者血清IGF-2水平及外周血单个核细胞IGF-2 mRNA水平明显降低,差异有显著意义。结论： OSAHS患者IGF-2水平明显增高，增高的IGF-2可能参与OSAHS的病理过程，特别是OSAHS引发心血管疾病的相关病理生理过程。     

不同程度鼾症患者睡眠结构及醒觉指数分析

目的:分析不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和单纯鼾症患者的多道睡眠图(PSG)的特点.方法:应用60道PSG监测仪对65例睡眠打鼾成人行整夜睡眠监测,并按照呼吸暂停低通气指数(AHI)将患者分为单纯鼾症组(Ⅰ组)、轻度OSAHS组(Ⅱ组)、中度OSAHS组(Ⅲ组)和重度OSAHS组(Ⅳ组),并比较各组间的PSG检测结果.结果:与单纯鼾症组相比,重度OSAHS组的非快速眼动睡眠(NREM)Ⅰ期所占的百分比增加(P＜0.001),快速眼动睡眠期(REM)所占的百分比减少(P＜0.05);四组鼾症患者的总醒觉指数(ArI)和伴有呼吸紊乱的觉醒指数均增加,自发性觉醒指数均减小;但各组间存在明显差异.NREMⅡ期所占的百分比、NREMⅢ Ⅳ期所占的百分比、睡眠效率等在四个鼾症患者组间比较无明显差异.结论:鼾症患者中睡眠结构紊乱及睡眠片段化与AHI的大小有关.     

阻塞性睡眠呼吸暂停低通气综合征合并心血管疾病患者同型半胱氨酸和血脂水平的检测分析

目的:检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并心血管疾病(CVD)患者的同型半胱氨酸(Hcy)和血脂水平,探讨其在OSAHS合并CVD中的作用。方法:收集本院OSAHS64例,分为单纯OSAHS组、OSAHS+CVD组,并选择单纯CVD和健康人群作为对照,分别行整夜多导睡眠监测(PSG)。测定呼吸暂停低通气指数(AHI)和血氧饱和度(SaO2)。同时采集空腹静脉血,检测血清Hcy以及总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。结果:OSAHS+CVD组的Hcy高于正常对照组、单纯OSAHS组和单纯CVD组(P<0.01);单纯OSAHS组、OSAHS+CVD组和单纯CVD组的TC、TG、LDL-C值均比正常对照组高(P<0.05~0.01),HDL-C值比正常对照组低(P<0.01),但三疾病组间无统计学差异。结论:OSAHS患者Hcy水平升高可能是OSAHS患者易患高血压、冠心病等心血管疾病的机制之一。     

重叠综合征患者血清肾上腺素及去甲肾上腺素表达水平的研究

目的 探讨血清肾上腺素(E)和去甲肾上腺素(NE)在重叠综合征(OS)中的表达及与患者缺氧程度的相关性.推测E及NE对重叠综合征的发生发展的作用.方法 选取慢性阻塞性肺疾病患者(单纯COPD组)、阻塞性睡眠呼吸暂停低通气综合征患者(单纯OSAHS组)、重叠综合征患者(OS组)及对照组各30例,四组患者均行肺功能检查及多导睡眠监测,记录睡眠呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、最长呼吸暂停时间(LAT).并采用酶联免疫法分别检测四组患者的E及NE的表达水平,对各项指标进行统计学处理.结果 (1)多导睡眠检测指标:OS组患者AHI、LAT均高于单纯OSAHS组、单纯COPD组、对照组(P＜0.05),而LSaO2、MSaO2均低于单纯OSAHS组、单纯COPD组、对照组(P＜0.05).(2)E及NE的表达水平:OS组患者的E及NE表达水平均高于单纯OSAHS组、单纯COPD组、对照组(P＜0.01).(3)各组E及NE与睡眠监测指标的相关性:OS组及OSAHS组患者血清E及NE与AHl、LAT呈正相关(P＜0.01),与LSaO2及MSaO2呈负相关(P＜0.05).COPD组患者血清E及NE与AHI、LAT无相关性(P＞0.05),与LSaO2及MSaO2呈负相关(P＜0.05).结论 OS患者较单纯COPD和OSAHS患者更易引起交感神经活性增强,E及NE表达水平的失调与病变严重程度密切相关.缺氧可能通过影响E及NE的水平促进重叠综合征病情的发生及发展.     

Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合症诊断中的应用

目的 探讨Epwoyth嗜睡量表对阻塞性睡眠呼吸暂停低通气综合症（OSAHS）临床诊断意义。方法 对83例鼾症、279例OSAHS患者（轻度65例、中度97例、重度117例）分别进行Epworth问卷调查并判断嗜睡评分（EP），然后行多导睡眠监测（PSG）。依据PSG检查将EP与相关资料做统计学分析。结果 鼾症、OSAHS患者EP评分与睡眠呼吸暂停-低通气指数（AHI）、夜间睡眠呼吸紊乱时间（T）呈明显正相关；EP与最低氧饱和度（SaO2）呈负相关。即OSAHS病情越重，EP评分越高。诊断符合率分别为：鼾症90．36％（75／83），轻度OSAHS92．3％（60／65），中度0SAHS91．75％（89／97），重度OSAHS92．3％（108／117）。结论 EP评分基本与病情相符，诊断符合率较高。可以用Epworth嗜睡量表作为临床OSAHS患者的初筛检查，尤其是在基层医院。     

伴有阻塞性睡眠呼吸暂停低通气综合征的糖尿病患者的临床特点分析

目的：探讨伴有阻塞性睡眠呼吸低通气暂停综合征的糖尿病患者的临床特点,以提高DM与OSAHS两病关系的认识。方法对在2009年1月~2012年12月资料完整的糖尿病患者进行多导睡眠监测,筛选出符合标准的130例患者。根据呼吸暂停低通气指数(AHI)将DM患者分为OSAHS组患者67例;非OSAHS组患者63例。检测血脂、糖代谢等指标并计算胰岛素抵抗指数,比较两组参数的差异。结果OSAHS组的DM患者在体质量指数(BMI)、睡眠呼吸暂停低通气指数(AHI)、最低脉搏容积血氧饱和度(LSpO2)、血清甘油三酯(TG)、糖化血红蛋白(HbA1c)、空腹胰岛素水平(FIns)、胰岛素抵抗指数(HOMA-IR)等参数均高于未伴有OSAHS的DM患者,差异有统计学意义(P<0.05)。 OSAHS组患者血清FIns及HOMA-IR与LSpO2和AHI均存在相关性。OSAHS组高血压和冠心病并发症明显高于非OSAHS组。结论伴有OSAHS的DM患者由于慢性间歇性低氧与IR相关,发生高血压、冠心病的可能性增大,医务工作者应该提高糖尿病患者人群OSAHS的识别。     

The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective Investigate the clinical features and the blood pressure (BP) pattern of the phenotype of excessive daytime sleepiness (EDS) in OSAHS.Methods A total of 508 Chinese adults with suspected OSAHS were referred to our sleep laboratory from October 2009 to May 2012. On the same night of polysomnography (PSG), the levels of blood pressure were measured before sleeping (bedtime BP) and immediately after waking up in the next morning (morning BP). EDS was recognized as Epworth Sleepiness Scale (ESS)≥9. Subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control (simple snoring) group (control, n=104) with AHI<5; mild group (mild, n=89) with AHI≥5 and <15; moderate group (moderate, n=70) with AHI≥15 and<30; and severe group (severe, n=245) with AHI ≥30. The differences and correlations between BP and PSG parameters in EDS and non-EDS group of OSAHS patients were analyzed.Results In all subjects, ESS was positively correlated with morning diastolic blood pressure (DBP), Mean arterial pressure (MAP) and bedtime DBP (r=0.144, 0.102 and 0.114, respectively, each P value<0.05). In OSAHS patients, ESS was only positively correlated with morning DBP (r=0.137, P<0.05). OSAHS patients with EDS phenotype were younger and were more likely to have the symptom of waking up feeling tired (36.1% vs. 23.2%, p=0.023), who had lower MSaO2, longer SIT90 (the ratio of time of SpO2 below 90% in total sleep time) and higher DBP (bedtime as well as morning). In patients with AHI≥15, ESS was correlated positively with both bedtime and morning DBP after controlling the confounding effects of age, sex, BMI, AHI and nadir nocturnal oxygen saturation( r=0.126,0.143, respectively, both P values<0.05). And in OSAHS patients of EDS phenotype, the bedtime DBP, bedtime MAP, morning DBP, and morning MAP were 3~5 mm Hg higher than that in patients of non-EDS phenotype(P<0.05). In the moderate and severe OSAHS group, patients with EDS phenotype were younger and had a lower mean blood oxygen saturation (MSaO2), longer time of SpO2 below 90% and higher SIT90 than patients with non-EDS phenotype (P<0.05). In hypertensive OSAHS patients, patients with EDS were also younger and had higher micro-arousal index (MiI), as well as higher morning DBP, morning MAP and bedtime DBP than that in non-EDS group (P<0.05).Conclusions EDS in OSAHS patients is a special phenotype, which was characterized by younger age, higher DBP and more severe hypoxic load. This feature is mainly manifested in moderate and severe OSAHS patients. It is very important to identify the phenotype of EDS in patients with OSAHS, who may meet more benefits from effective treatment of OSAHS by correcting the intermittent nocturnal hypoxia and sleep fragmentation.     

Effect of nocturnal hypoxia on pulmonary hemodynamics in patients with obstructive sleep apnea

Effects of apnoea induced nocturnal hypoxia on pulmonary haemodynamics (PH) in pts with OSA are still under debate. We studied PH in 67 pts (64 M and 3 F) mean +/- SD: age 45 +/- 8 years, with severe OSA, AHI 62 +/- 22. Patients had normal spirometry: FVC 98 +/- 15% N, FEV1 97 +/- 16% N and arterial blood gases--PaO2 72 +/- 10 mmHg, PaCO2 40 +/- 4 mmHg. PH were studied using Swan-Ganz thermodilution catheter. PH were within normal range: right atrial pressure 4.2 +/- 2.7 mmHg, right ventricular systolic/enddiastolic pressure 28.1 +/- 7.1/5.0 +/- 3.3 mmHg, mean pulmonary artery pressure (PAP) 15.8 +/- 4.6 mmHg, mean pulmonary wedge pressure (PW) 6.8 +/- 3.1 mmHg, cardiac output (CO) 5.6 +/- 2.2 L/min. and pulmonary vascular resistance (PVR) 150 +/- 83 dyn.sec.cm-5. During exercise (44 pts) PAP rose from 15.8 +/- 4.3 to 29.8 +/- 9.4 mmHg, PW rose from 6.8 +/- 3.2 to 12.6 +/- 6.8 mmHg and CO from 4.9 +/- 1.9 to 9.2 +/- 4.2 L/min. All patients presented with nocturnal desaturations. Mean oxygen saturation (SaO2 mean) was: 87.4 +/- 5.4%, minimal saturation (SaO2 min) was 57.4 +/- 15.9%. Time spent in desaturation SaO2 < 90% (T90) was 50.7 +/- 26.5%. Results of PH investigations were related to results of pulse oximetry. Linear regression analysis showed week negative correlations between SaO2 mean and: PAP (r = -0.37 p = 0.003), PVR (r = -0.37 p = 0.007), and positive correlation between T90 and PAP (r = 0.37 p = 0.008). We conclude that there is no diurnal pulmonary hypertension at rest in patients with severe OSA and normal lung function even in the presence of severe overnight nocturnal desaturations. In half of studied patients we observed pulmonary hypertension during exercise.     

吸烟对动态血压及动脉硬化指数影响的相关性分析

目的 分析吸烟对动态血压及动脉硬化指数影响的相关性。方法 选取四会万隆医院心内科2018年1月~12月收治的120例高血压患者设为观察组,另选同期120例健康体检者为对照组,分别比较观察组与对照组、观察组内吸烟患者与不吸烟患者动态血压（24h平均收缩压、24h平均舒张压）、动脉硬化指数,并使用Pearson相关性分析法对其相关性进行检验。结果 观察组24h平均收缩压（134.65±2.10）mmHg、24h平均舒张压（86.20±2.45）mmHg、动脉硬化指数（0.67±0.05）,分别高于对照组的（117.45±2.35）mmHg、（75.25±2.70）mmHg、（0.52±0.03）,差异有统计学意义（P＜0.05）;观察组吸烟患者24h平均收缩压（137.21±2.40）mmHg、24h平均舒张压（90.20±2.35）mmHg、动脉硬化指数（0.75±0.05）,高于不吸烟患者的（132.48±2.32）mmHg、（82.49±2.41）mmHg、（0.61±0.08）,差异有统计学意义（P＜0.05）;Pearson相关性分析结果提示,吸烟与动态血压及动脉硬化指数呈正相关性（r=0.68、0.85,P＜0.05）。结论 吸烟与动态血压及动脉性硬化指数之间存在着密切的关联性,戒烟有助于遏制高血压及动脉粥样硬化的进一步恶化。     

血浆B型利钠肽预测肺动脉高压的价值

目的:探讨血浆B型利钠肽(BNP)浓度预测肺动脉高压的价值。方法:采用化学发光微粒子免疫分析(CMIA)测定48例肺动脉高压患者和46例健康体检正常者外周血浆BNP浓度。超声心动图根据三尖瓣返流估测肺动脉收缩压(SPAP)。比较正常对照组和肺动脉高压组血浆BNP浓度以及统计分析血浆BNP浓度与肺动脉高压之间相关性。结果:正常对照组血浆BNP浓度与肺动脉高压组有显著性差异(P<0.05),轻、中度肺动脉高压组与重度肺动脉高压组血浆BNP浓度无统计学差异(P>0.05),血浆BNP浓度与肺动脉高压有相关性(r=0.394,P<0.01)。结论:血浆BNP浓度与肺动脉高压存在相关性,但血浆BNP浓度并不代表肺动脉高压严重程度。     

原发性高血压患者血压晨峰的相关因素分析

目的研究原发性高血压患者血压晨峰（MBPS）的发生情况及相关因素。方法采用24h动态血压监测仪（ABPM）分析415例原发性高血压患者的血压,确认晨峰组与非晨峰组,对两组性别、年龄、动态血压、动态心电图及超声心动图、颈动脉彩色多普勒检查结果、血脂、空腹血糖、体重指数（BMI）进行比较分析。结果①有晨峰现象的129例（MBPS组）,发生率为31.1%,与非MBPS组相比较,MBPS组24h平均收缩压、脉压均显著高于非MBPS组（P〈0.001）。②凌晨血压增高与年龄相关（P〈0.01）,调整年龄后,男女MBPS发生率分别为28.5%,16.9%,男性明显高于女性（P=0.0105）。③不论男女,MBPS组的左室肥厚发生率、左室重量指数（LVMI）、颈动脉内膜中层厚度（IMT）、24h平均心率、房性早搏、室性早搏的发生率均高于非MBPS组,差别有统计学意义（P〈0.001）,MBPS与BMI、空腹血糖、血脂无显著关联。结论原发性高血压患者MBPS与年龄、性别、心室重构、心律失常密切相关,MBPS患者有更明显的颈动脉粥样硬化。MBPS可能使清晨心血管事件的风险增加。     

阻塞性睡眠呼吸暂停综合征患者血清IL-6、TNF-α测定的临床意义

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者血清IL-6、TNF-α水平测定的临床意义。方法:68例OSAS患者分为轻度组(36例)和中、重度组(32例),同时选取健康对照者30例,采用酶联免疫吸附法(ELISA)测定其血清IL-6、TNF-α水平,同时检测睡眠呼吸暂停低通气指数(AHI)及夜间最低血氧饱和度(SaO2),并进行相关性分析。32例中、重度OSAS患者经鼻持续正压通气(nCPAP)治疗,于治疗前及治疗后监测AHI、SaO2、IL-6和TNF-α水平。结果:OSAS患者AHI和血清IL-6、TNF-α水平显著高于对照组(P<0.01),平均SaO2和最低SaO2与对照组相比明显降低(P<0.01)。中、重度OSAS患者经nCPAP后AHI和最低SaO2明显改善,血清IL-6和TNF-α水平均较治疗前明显降低(P<0.01)。OSAS患者血清IL-6、TNF-α水平分别与AHI呈正相关(r=0.75,r=0.82,P<0.01);与SaO2呈负相关(r=-0.65、r=-0.74,P<0.01)。结论:血清IL-6、TNF-α参与了OSAS的发病,而且与病情严重程度密切相关。     

Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome

STUDY OBJECTIVES: To investigate flow-mediated dilatation (FMD) and C-reactive protein (CRP) levels in patients with obstructive sleep apnea syndrome (OSAS) in relation with the severity of respiratory disturbances and hypoxemia. DESIGN: After subjects had completed nocturnal polysomnography, FMD was measured in the brachial artery, and blood samples were obtained to determine serum CRP levels. SETTING: Sleep laboratory in Seoul National University Bundang Hospital. PATIENTS: Ninety men: 22 normal controls, 28 subjects with mild to moderate OSAS, and 40 with severe OSAS. MEASUREMENTS AND RESULTS: FMD was found to be correlated with oxygen desaturation index (ODI), percentage of time below 90% O2 saturation, average O2 saturation, lowest O2 saturation, systolic blood pressure, apnea hypopnea index (AHI), and body mass index. In addition, CRP was correlated with body mass index, waist-to-hip ratio, neck circumference, diastolic pressure, average O2 saturation and percentage of time below 90% O2 saturation but not with AHI. Stepwise multiple regression showed that the ODI was a significant determinant of FMD (adjusted R2 = 10%, beta = -0.33, P < 0.01). In addition, body mass index (beta = 0.25, P < 0.05) and waist-to-hip ratio (beta = 0.21, P < 0.05) were found to be significantly correlated with CRP (adjusted R2 = 12%, P < 0.05), independently of other factors. There was no correlation between FMD and CRP. CONCLUSION: As a marker of nocturnal hypoxemia, ODI rather than AHI might better explain the relationship between OSAS and FMD. Because body mass index and waist-to-hip ratio were identified as risk factors of high serum CRP in OSAS, obesity should be considered when predicting cardiovascular complications in OSAS.     

基于Meta分析的CPAP联合常规降压药物对OSAHS合并高血压患者的综合疗效分析

目的利用Meta分析评价持续气道正压通气(continuous positive airway pressure,CPAP)联合常规降压药物对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)合并高血压患者的综合疗效,为临床治疗提供参考。方法计算机检索中国生物医学文献数据库(Chinese Bio Medical Literature Database,CBM)、Cochrane Library、Pub Med、中国学术期刊全文数据库(China National Knowledge Infrastructure,CNKI)、万方数据知识服务平台,维普中文期刊服务平台等电子数据库并手工检索相关期刊,查找CPAP治疗对OSAHS合并高血压患者综合疗效影响的临床随机对照试验(randomized controlled trial,RCT),对符合条件的RCT,逐一评价纳入研究的质量,提取入选文献资料,采用Rev Man5.3软件进行Meta分析,以Meta分析中的合并效应统计参数探讨CPAP联合常规降压药物的治疗效果。结果共纳入13篇文献。Meta分析数据显示:各项指标差异均具有统计学意义[AHI:WMD=-25.19,95%CI(-34.05,-16.33),P0.00001;LSa O2:WMD=17.57,95%CI(11.16,23.98),P0.00001。白天平均收缩压:WMD=-8.26,95%CI(-11.18,-5.34),P0.00001;白天平均舒张压:WMD=-6.42,95%CI(-8.25,-4.60),P0.00001;夜间平均收缩压:WMD=-12.92,95%CI(-19.65,-6.19),P0.0002;夜间平均舒张压:WMD=-6.31,95%CI(-8.53,-4.09),P0.00001;24h平均收缩压:WMD=-10.28,95%CI(-14.08,-6.48),P0.00001;24h平均舒张压:WMD=-6.99,95%CI(-8.88,-5.09),P0.00001]。分析数据提示CPAP联合常规降压药物治疗后OSAHS合并高血压患者各项指标改善程度较对照组(常规药物治疗)均有明显提升。漏斗图基本对称,存在发表偏倚可能性小。结论 CPAP联合常规降压药物治疗对我国OSAHS合并高血压患者有确切的疗效。