Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Multidisciplinary Sleep Unit, Department of Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Sleep Res. 2018 Apr;27(2):232-239. doi: 10.1111/jsr.12571. Epub 2017 Jun 20.
Obstructive sleep apnea syndrome is very prevalent in hypertensive subjects. Moreover, obstructive sleep apnea syndrome activates multiple processes that might be associated with silent cerebral infarct independently of established risk factors. Our aim is to estimate the frequency of obstructive sleep apnea syndrome in hypertensive patients with and without silent cerebral infarct, and to determine whether obstructive sleep apnea syndrome is an independent risk factor of silent cerebral infarct and/or lacunar silent cerebral infarct in patients with hypertension. In this matched cross-sectional study performed in hypertensive subjects, each patient with silent cerebral infarct detected by magnetic resonance imaging was matched with two patients without silent cerebral infarct. Polysomnographic studies were performed, and the apnea-hypopnea index was calculated. Severe obstructive sleep apnea syndrome was considered in those with apnea-hypopnea index >30. One-hundred and eighty-three patients, 61 with silent cerebral infarct and 122 without silent cerebral infarct, were evaluated. The mean age was 64.1 ± 4.5 years, and 72.1% were men. The frequency of severe obstructive sleep apnea syndrome was 44.3% in patients with silent cerebral infarct and 38.5% in the control group. An adjusted conditional logistic regression model did not show a significant increased risk of silent cerebral infarct in patients with severe obstructive sleep apnea syndrome (odds ratio 1.362; 95% confidence interval: 0.659-2.813; P = 0.404). Forty-three patients (70.5%) of the silent cerebral infarct were lacunar. The presence of severe obstructive sleep apnea syndrome was significantly higher in lacunar silent cerebral infarct when compared with patients without lacunar infarcts (55.8% versus 35.7%, P = 0.019), being independently associated on an adjusted logistic regression model (odds ratio 2.177; 95% confidence interval: 1.058-4.479; P = 0.035). In conclusion, severe obstructive sleep apnea syndrome is highly prevalent among hypertensive subjects, and is independently associated with lacunar silent cerebral infarct.
阻塞性睡眠呼吸暂停综合征在高血压患者中非常普遍。此外，阻塞性睡眠呼吸暂停综合征激活了多种可能与无症状性脑梗死独立相关的过程，而与已确立的危险因素无关。我们的目的是评估伴有和不伴有无症状性脑梗死的高血压患者中阻塞性睡眠呼吸暂停综合征的频率，并确定阻塞性睡眠呼吸暂停综合征是否是高血压患者无症状性脑梗死和/或腔隙性无症状性脑梗死的独立危险因素。在这项针对高血压患者的匹配横断面研究中，对每位通过磁共振成像检测到无症状性脑梗死的患者进行了与两名无无症状性脑梗死患者的匹配。进行了多导睡眠图研究，并计算了呼吸暂停低通气指数。将呼吸暂停低通气指数>30 的患者视为严重阻塞性睡眠呼吸暂停综合征。共评估了 183 名患者，其中 61 名患有无症状性脑梗死，122 名无无症状性脑梗死。平均年龄为 64.1±4.5 岁，72.1%为男性。患有无症状性脑梗死的患者中严重阻塞性睡眠呼吸暂停综合征的发生率为 44.3%，对照组为 38.5%。调整后的条件逻辑回归模型显示，严重阻塞性睡眠呼吸暂停综合征患者发生无症状性脑梗死的风险无显著增加（比值比 1.362；95%置信区间：0.659-2.813；P=0.404）。43 名（70.5%）无症状性脑梗死患者为腔隙性脑梗死。与无腔隙性梗死患者相比，腔隙性无症状性脑梗死患者严重阻塞性睡眠呼吸暂停综合征的发生率明显更高（55.8%比 35.7%，P=0.019），并在调整后的逻辑回归模型中独立相关（比值比 2.177；95%置信区间：1.058-4.479；P=0.035）。总之，严重阻塞性睡眠呼吸暂停综合征在高血压患者中非常普遍，并且与腔隙性无症状性脑梗死独立相关。
