缺血性脑血管病患者阻塞性睡眠呼吸暂停低通气综合征与有症状颈动脉狭窄的关系

目的 探讨缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与颈动脉狭窄的关系,为制定颈动脉狭窄的干预策略提供参考.方法 从南京卒中注册系统中筛选出87例ICVD患者,根据呼吸暂停低通气指数(apnea-hypopnea index,AHI)将患者分为无OSAHS组(n=21)以及轻度(n=24)、中度(n=27)和重度(n=11)OSAHS组;另外,根据数字减影血管造影(digital subtraction angiography,DSA)结果,将患者分为无颈动脉狭窄组(n=34)和颈动脉狭窄组(n=49).分析脑血管病危险因素和OSAHS对ICVD患者颈动脉狭窄的影响.结果 无OSAHS以及轻度、中度和重度OSAHS组之间饮酒(χ2=8.56,P=0.036)、高血压(χ2=13.2,P=0.004)和颈动脉狭窄(χ2=22.97,P=0.006)患者比例均存在显著差异.单因素分析显示,年龄(OR=1.066,95% CI 1.023～1.112;P=0.003)、高血压(OR=3.587,95%CI 1.294～9.949;P=0.014)、饮酒(OR=5.275,95%CI 1.855～15.001,P=0.002)和OSAHS(OR=1.073,95%CI 1.033～1.115,P=0.000)是颈动脉狭窄的危险因素;多变量logistic回归分析显示,年龄(OR=1.113,95%CI 1.047～1.182;P=0.001)、OSAHS(OR=1.096,95%CI 1.034～1.160;P=0.000)、饮酒(OR=4.292,95% CI 1.217～15.139;P=0.024)是颈动脉狭窄的独立危险因素.Spearman等级相关分析提示,AHI水平与颈动脉狭窄程度呈正相关(r=0.435,P=0.000).无颈动脉病变组(n=34)、单侧病变组(n=22)和双侧病变组(n=27)AHI存在显著差异(12.97±10.04)次/h对(21.40±16.38)次/h对(29.33±13.81)次/h,F=11.64,P<0.01].结论 OSAHS是颈动脉狭窄的独立危险因素,且与颈动脉狭窄严重程度呈正相关.AHI在一定程度上能反映颈动脉狭窄程度和颈部血管受累范围.

Relationship between obstructive sleep apnea-hypopnea syndrome and symptomatic carotid stenosis in patients with ischemic cerebrovascular disease

Objective To investigate the relationship between obstructive sleep apneahypopnea syndrome (OSAHS) and carotid stenosis in patients with ischemic cerebrovascular disease (ICVD) and to provide reference for developing the intervention strategy of carotid stenosis. Methods Eighty-seven patients with ICVD were screened from Nanjing Stroke Registry Program. The patients were divided into without (n=21), mild(n=24), moderate (n=27) and severe (n = 11) OSAHS groups according to the apnea-hypopnea index (AHI); in addition, the patients were divided into with (n =34) and without carotid stenosis (n=49) groups according to the results of digital subtraction angiography (DSA). The effects of the risk factors for cerebrovascular diseases and OSAHS on carotid stenosis in patients with ICDV were analyzed.Results There were significant differences in the proportions of alcohol consumption (χ2=8.56, P =0. 036), hypertension (χ2 = 13.20, P =0. 004) and carotid stenosis (χ2 =22.97, P =0. 006) between the no OSAHS and the mild, moderate and severe OSAHS groups. The univariate analysis showed that age (OR = 1. 066, 95% CI 1. 023- 1.112; P = 0. 003),hypertension (OR =3.587, 95% CI 1. 294- 9. 949; P =0. 014), alcohol consumption (OR =5.275,95% CI 1.855-15.001; P= 0.002) and OSAHS (OR= 1.073, 95% CI 1.033-1.115; P = 0. 000) were the risk factors for carotid stenosis. The multivariate logistic regression analysis showed that age (OR = 1. 113, 95% CI 1. 047-1. 182; P =0. 001), OSAHS (OR = 1. 096, 95% CI 1. 034-1. 160; P = 0. 000), and alcohol consumption (OR = 4. 292,95% CI 1. 217-15. 139; P = 0. 024) were the independent risk factors for carotid stenosis.Spearman rank correlation analysis suggested that the AHI levels were positively correlated with the degree of carotid stenosis (r = 0. 435, P = 0. 000). There were significant differences among the without stenosis (n =34), unilateral stenosis (n =22), and bilateral stenosis (n=27)groups (12.97 ± 10.04 vs. 21.40 ± 16.38 vs. 29.33 ± 13.81, F= 11.64, P<0.01).Conclusions OSAHS is an independent risk factor for carotid stenosis and it was positively correlated with the severity of carotid stenosis. AHI may reflect the degree of carotid stenosis and the range of neck vascular involvement to some extent.