阻塞性睡眠呼吸暂停不同亚型患者脂代谢紊乱的初步研究

Preliminary exploration of lipid metabolism disorders in patients with different subtypes of obstructive sleep apnea

摘要:

目的 初步探索阻塞性睡眠呼吸暂停（OSA）不同亚型的脂代谢紊乱差异。方法 选取2017年1月—2019年12月就诊于郑州大学第一附属医院经多导睡眠监测（PSG）确诊的成年OSA患者848例。根据OSA严重程度及基于年龄、性别、绝经状态的不同亚型分组，比较各组血脂水平的差异。结果 男性比例、BMI、吸烟史和高血压病史、呼吸暂停低通气指数（AHI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）随着OSA严重程度增加而逐渐升高（P <0.05），夜间最低血氧饱和度（LSaO₂）、高密度脂蛋白（HDL）随着OSA严重程度增加而逐渐降低（P <0.05）。非老年男性组AHI、TG高于非老年女性组，HDL、LSaO₂低于非老年女性组（P <0.05）；老年男性组LSaO₂高于老年女性组（P <0.05）；老年男性组AHI、TC）、TG、LDL低于非老年男性组，LSaO₂、HDL高于非老年男性组（P <0.05）；老年女性组AHI高于非老年女性组（P <0.05）。绝经后女性组AHI高于未绝经女性组（P <0.05）。高血压组AHI高于非高血压组，TC、HDL、LDL低于非高血压组（P <0.05）。结论 不同亚型OSA患者的血脂异常存在差异。OSA患者血脂异常与性别、年龄相关，非老年男性血脂变化更加显著。对OSA患者不同亚型分别进行综合评估，对于心脑血管并发症的管理有重要意义。

Abstract:

Objective To explore the discrepancies of lipid metabolism disorders in patients with different subtypes of obstructive sleep apnea (OSA).Methods A total of 848 adult patients with OSA diagnosed by polysomnography (PSG) in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019 were included. The lipid levels were compared among patients in different subgroups divided by the severity of OSA, age, sex and menopausal status.Results The percentage of males, body mass index (BMI), the proportions of patients with a history of smoking and hypertension, apnea hypopnea index (AHI), and the levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein (LDL) increased with the severity of OSA (P < 0.05), while the lowest oxygen saturation (LSaO₂) and the level of high-density lipoprotein (HDL) decreased with the severity of OSA (P < 0.05). Compared with the non-elderly female patients, AHI and the level of TG were higher but the level of HDL and LSaO₂ were lower in the non-elderly male patients (P < 0.05). The LSaO₂ was higher in the elderly male patients than that in the elderly female patients (P < 0.05). AHI and the levels of TC, TG and LDL in the elderly male patients were lower than those in the non-elderly male patients, whereas the LSaO₂ and the level of HDL in the elderly male patients were higher than those in the non-elderly male patients (P < 0.05). AHI in the elderly female patients was higher than that in the non-elderly female patients (P < 0.05), and AHI in postmenopausal female patients was higher than that in premenopausal female patients (P < 0.05). Compared with those without hypertension, patients with hypertension exhibited higher AHI and lower levels of TC, HDL and LDL (P < 0.05).Conclusions The dyslipidemia is discrepant among patients with different subtypes of OSA, and is related to gender and age of OSA patients. The changes in lipid profiles are particularly remarkable in non-elderly men. Thus, comprehensive evaluation of OSA patients according to their subtypes is of great significance for the management of cardiovascular and cerebrovascular complications.