阻塞性睡眠呼吸暂停成年患者的颅面与上气道形态与心血管风险的关联

Association of Craniofacial and Upper Airway Morphology with Cardiovascular Risk in Adults with OSA.

作者信息

Zhang Li, Zhang Xiaolei, Li Yi Ming, Xiang Bo Yun, Han Teng, Wang Yan, Wang Chen

机构信息

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.

National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.

出版信息

Nat Sci Sleep. 2021 Oct 1;13:1689-1700. doi: 10.2147/NSS.S332117. eCollection 2021.

DOI:10.2147/NSS.S332117

PMID:34629918

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8493274/

Abstract

BACKGROUND AND OBJECTIVE

Clinical and population-based studies have demonstrated a strong association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD). Anatomical abnormalities of the craniofacial region and upper airway are important risk factors for OSA. The objective of this study was to investigate the association of craniofacial and upper airway morphology with CVD risk biomarkers.

METHODS

One hundred and sixty-nine male patients with OSA underwent in-laboratory polysomnography (PSG) and upper airway computed tomography (CT) scanning. Ten-year Framingham CVD risk score (FRS) was calculated and categorized into low- and moderate-to-high-risk groups. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured as a biomarker of increased myocardial wall stress.

RESULTS

Compared to the low-risk group, total sleep time (TST), the proportion of N3 (N3%) and mean oxygen saturation (SpOmean) were lower, while the arousal index of non-rapid eye movement (NREM) sleep, apnea index (AI) of NREM sleep, apnea hypopnea index (AHI) of NREM sleep, oxygen desaturation index (ODI) and percentage of total sleep time spent with oxyhemoglobin saturation below 90% (TST90) were higher in the moderate-to-high risk group. The corrected upper airway length (UAL), ANB angle and gonion-gnathion-hyoid angle were larger for subjects in the moderate-to-high risk group than those in the low-risk group. In multiple regression analysis, TST, AI and adjusted UAL were independently associated with moderate-to-high CVD risk. Plasma NT-proBNP levels were higher in patients in the moderate- to high-risk group, and among the PSG and CT scan parameters, only SPOmean was marginally associated with NT-proBNP (r=0.183, P=0.054).

CONCLUSION

Craniofacial and upper airway features may contain valid cues about CVD risk, and sleep duration, obstructive event type and occurrence phase may be closely related to CVD risk for patients with OSA.

摘要

背景与目的

临床研究和基于人群的研究表明，阻塞性睡眠呼吸暂停（OSA）与心血管疾病（CVD）之间存在密切关联。颅面区域和上气道的解剖结构异常是OSA的重要危险因素。本研究的目的是探讨颅面及上气道形态与CVD风险生物标志物之间的关联。

方法

169例男性OSA患者接受了实验室多导睡眠图（PSG）检查和上气道计算机断层扫描（CT）。计算10年弗雷明汉心血管疾病风险评分（FRS），并将其分为低风险组和中高风险组。测量N末端B型利钠肽原（NT-proBNP）作为心肌壁应力增加的生物标志物。

结果

与低风险组相比，中高风险组的总睡眠时间（TST）、N3期比例（N3%）和平均血氧饱和度（SpOmean）较低，而非快速眼动（NREM）睡眠的觉醒指数、NREM睡眠呼吸暂停指数（AI）、NREM睡眠呼吸暂停低通气指数（AHI）、氧饱和度下降指数（ODI）以及血氧饱和度低于90%的总睡眠时间百分比（TST90）较高。中高风险组受试者的校正上气道长度（UAL）、ANB角和下颌角-颏前点-舌骨角均大于低风险组。在多元回归分析中，TST、AI和校正后的UAL与中高心血管疾病风险独立相关。中高风险组患者的血浆NT-proBNP水平较高，在PSG和CT扫描参数中，只有SpOmean与NT-proBNP有微弱关联（r=0.183，P=0.054）。