阻塞性睡眠呼吸暂停患者血管并发症与脑血管反应性及内皮功能障碍的关系

[The relationship of vascular complications with cerebrovascular reactivity and endothelial dysfunction in patients with obstructive sleep apnea].

作者信息

Rubina S S, Makarova I I, Yusufov A A

机构信息

Tver State Medical University, Tver, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(5. Vyp. 2):82-88. doi: 10.17116/jnevro202312305282.

Abstract

OBJECTIVE

To assess the relationship of vascular complications with cerebrovascular reactivity (CVR) and endothelial dysfunction in patients with obstructive sleep apnea (OSA).

MATERIAL AND METHODS

One hundred and twelve patients were examined. The patients were stratified into the main group with moderate and severe OSA and the control group without apnea. All patients underwent anthropometry, polysomnography, transcranial dopplerography and duplex scanning of the brachial artery.

RESULTS

Patients with OSA showed a more frequent decrease in post-occlusive vascular dilatation. The CVR indices in the hypercapnic test in the main group were in the range of 0.91-0.97 and significantly lower after 1 minute on the left, after 5 minutes on both sides and after 10 minutes on the left. A positive correlation during a hypercapnic test between the CVR on the left after 10 minutes and the desaturation index (=0.287, =0.021), between the CVR on the left after 5 and 10 minutes and acute cerebrovascular accident (=0.248, =0.048 and =0.285, =0.022, respectively), as well as a negative correlation between the indicators of the middle cerebral artery and chronic cerebral ischemia were established in patients with apnea.

CONCLUSION

Timely assessment of pathological changes in central and peripheral hemodynamics in patients with OSA will allow diagnosing early signs of vascular complications, which will further improve the personalized strategy for the prevention of stroke and chronic cerebral ischemia.

摘要

目的

评估阻塞性睡眠呼吸暂停(OSA)患者血管并发症与脑血管反应性(CVR)及内皮功能障碍之间的关系。

材料与方法

对112例患者进行检查。将患者分为中度和重度OSA的主要组和无呼吸暂停的对照组。所有患者均接受人体测量、多导睡眠图、经颅多普勒超声检查和肱动脉双功扫描。

结果

OSA患者闭塞后血管扩张的降低更为常见。主要组高碳酸血症试验中的CVR指数在0.91 - 0.97范围内,左侧1分钟后、双侧5分钟后和左侧10分钟后显著降低。在高碳酸血症试验中,10分钟后左侧CVR与去饱和指数之间呈正相关(=0.287,=0.021),5分钟和10分钟后左侧CVR与急性脑血管意外之间呈正相关(分别为=0.248,=0.048和=0.285,=0.022),并且在呼吸暂停患者中,大脑中动脉指标与慢性脑缺血之间呈负相关。

结论

及时评估OSA患者中枢和外周血流动力学的病理变化将有助于诊断血管并发症的早期迹象,这将进一步改善预防中风和慢性脑缺血的个性化策略。

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