中重度阻塞性睡眠呼吸暂停与脑小血管病有关。
Moderate-to-severe obstructive sleep apnea is associated with cerebral small vessel disease.
机构信息
Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
出版信息
Sleep Med. 2017 Feb;30:36-42. doi: 10.1016/j.sleep.2016.03.006. Epub 2016 May 4.
BACKGROUND
Cerebral small vessel disease (SVD) is associated with increased risk of cerebral infarction and hemorrhage. Obstructive sleep apnea (OSA) is known to increase the risk of cerebrovascular disease. This study aimed to investigate the association between cerebral SVD and severity of OSA.
METHODS
A total of 170 patients were included from the patient registry at the present Sleep Center; these patients underwent both magnetic resonance imaging (MRI) of the brain and polysomnography (PSG) for suspected OSA. The presence and burden of white matter hyperintensities (WMHs), asymptomatic lacunar infarctions (ALIs), cerebral microbleeds (CMBs), and perivascular spaces (PVSs) were determined by MRI, and their relationships with the apnea-hypopnea index (AHI), as determined by PSG, were investigated.
RESULTS
Among the 170 patients, 25 (14.7%) had high-grade WMHs, 21 (12.4%) had ALIs, 21 (12.4%) had CMBs, and 34 (20.0%) had high-grade PVSs. In the multivariable analysis, after adjusting for factors including age, sex, and other variables for which p <0.1 in univariable analysis (hypertension, diabetes mellitus, previous stroke, minimal SaO and arousal index), moderate-to-severe OSA was associated with high-grade WMHs (odds ratio [OR] 4.72; 95% confidence interval [CI] 1.14-19.47), CMBs (OR 3.47; 95% CI 0.89-15.18), or high-grade PVSs (OR 3.64; 95% CI 1.02-13.01), but not with ALIs. The total SVD score was independently associated with increased AHI (p = 0.017), particularly in patients with moderate-to-severe OSA (β [standard error] = 0.448 (0.204), p = 0.030].
CONCLUSION
Moderate-to-severe OSA is positively associated with multiple indicators of cerebral SVD, including WMHs, CMBs, and PVSs.
背景
脑小血管病（SVD）与脑梗死和脑出血风险增加相关。阻塞性睡眠呼吸暂停（OSA）已知会增加脑血管疾病的风险。本研究旨在探讨脑 SVD 与 OSA 严重程度之间的关系。
方法
从本睡眠中心的患者登记处共纳入 170 例患者；这些患者均接受脑部磁共振成像（MRI）和多导睡眠图（PSG）检查以疑似 OSA。通过 MRI 确定脑白质高信号（WMHs）、无症状性腔隙性梗死（ALIs）、脑微出血（CMBs）和血管周围间隙（PVSs）的存在和负担，并研究其与 PSG 确定的呼吸暂停低通气指数（AHI）的关系。
结果
在 170 例患者中，25 例（14.7%）存在高级别 WMHs，21 例（12.4%）存在 ALIs，21 例（12.4%）存在 CMBs，34 例（20.0%）存在高级别 PVSs。在多变量分析中，在校正年龄、性别和其他单变量分析中 p<0.1 的因素（高血压、糖尿病、既往卒中、最低 SaO2 和觉醒指数）后，中重度 OSA 与高级别 WMHs（比值比 [OR] 4.72；95%置信区间 [CI] 1.14-19.47）、CMBs（OR 3.47；95% CI 0.89-15.18）或高级别 PVSs（OR 3.64；95% CI 1.02-13.01）相关，但与 ALIs 无关。总 SVD 评分与 AHI 增加独立相关（p=0.017），尤其是在中重度 OSA 患者中（β[标准误]0.448（0.204），p=0.030）。
结论
中重度 OSA 与脑 SVD 的多个指标呈正相关，包括 WMHs、CMBs 和 PVSs。
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