Gao Yinghui, Wen Yongfei, Qian Xiaoshun, Zhao Libo, Xu Hu, Xu Weihao, Kong Xiaoxuan, Che Hebin, Wang Yabin, Liu Lin
PKU-UPenn Sleep Center, Peking University International Hospital, Beijing 102206, China.
Department of Pulmonary and Critical Care Medicine, General Hospital of PLA, Beijing 100853, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Nov 30;40(11):1587-1592. doi: 10.12122/j.issn.1673-4254.2020.11.08.
To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications.
Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI < 15) and moderate to severe OSA group (AHI ≥ 15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups.
Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 0.17±0.04, =0.032) and serum creatinine level (70.94± 27.88 54.49±34.22 μmol/L, =0.022). The left ventricular ejection fraction, interventricular septal thickness, left ventricular posterior wall thickness, left atrial diameter and left ventricular end-diastolic diameter were all similar between the two groups. With a similar early diastolic mitral flow velocity (E) between the two groups, the patients with moderate to severe OSA had a significantly higher late diastolic mitral flow velocity (A) (70.35±6.87 64.09±8.31, =0.0001) and a significantly lower E/A ratio (0.98±0.06 1.08±0.05, =0.0001) than the patients with mild OSA. Multiple linear regression showed that the E/A ratio was negatively correlated with AHI (β =- 0.645, =0.0001).
Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.
评估无心血管并发症的老年阻塞性睡眠呼吸暂停综合征（OSA）患者心脏结构和功能的变化及其危险因素。
选取2015年1月至2016年10月收治的82例无心血管疾病的老年OSA患者。根据其呼吸暂停低通气指数（AHI，计算为每小时睡眠中呼吸暂停和低通气发作的平均次数），将患者分为轻度OSA组（AHI<15）和中重度OSA组（AHI≥15）。记录人口统计学数据和一般临床资料，并在多导睡眠图监测后的次日早晨采集患者空腹血样进行血细胞分析和生化检查。在夜间多导睡眠图检查后一周内进行超声心动图检查，比较两组患者的心脏结构、心脏功能和生化指标。
与轻度OSA组患者相比，中重度OSA组患者的血细胞比容（0.22±0.08对0.17±0.04，P=0.032）和血清肌酐水平（70.94±27.88对54.49±34.22μmol/L，P=0.022）显著更高。两组患者的左心室射血分数、室间隔厚度、左心室后壁厚度、左心房直径和左心室舒张末期直径均相似。两组患者的二尖瓣舒张早期血流速度（E）相似，但中重度OSA组患者的二尖瓣舒张晚期血流速度（A）显著更高（70.35±6.87对64.09±8.31，P=0.0001），E/A比值显著更低（0.98±0.06对1.08±0.05，P=0.0001）。多元线性回归显示，E/A比值与AHI呈负相关（β=-0.645，P=0.0001）。
无高血压或其他心血管疾病的老年中重度OSA患者可能出现心脏舒张功能损害，且损害程度与AHI呈正相关。
