Analysis of all-night evaluation indexes and predictors of cardiovascular risk in patients with obstructive sleep apnea-hypopnea syndrome

doi:10.19983/j.issn.2096-8493.2024132

Abstract

Abstract:

Objective: To explore overnight assessment indicators and cardiovascular disease risk predicators of obstructive sleep apnea using portable sleep monitoring. Methods: A retrospective, clinical case analysis was used to screen 192 outpatients and inpatients from May 2019 to July 2020. Physical measurements, blood pressure, past medical history, and biochemical indicators of the patients were recorded. Data of AHI, lowest oxygen saturation, average oxygen saturation, longest apnea duration, longest hypopnea duration, the ratio of overnight oxygen saturation below 90%, the ratio of total apnea time to sleep time, the ratio of total hypopnea time to sleep time and Epworth sleepiness scale were collected for analysis. According to the criteria, 152 patients were included for ASCVD risk analysis with China-PAR model, PM indexes that influence ASCVD risk were analyzed. Results: One hundred and seventy-nine patients diagnosed with obstructive sleep apnea-hypopnea syndrome. Among PM monitoring indexes, lowest oxygen saturation (OR=0.84, P=0.002) and longest apnea duration (OR=0.96, P=0.017) were negative corrected to AHI, total apnea time to sleep time ratio (OR=1.89, P<0.001), total hypopnea time to sleep time ratio (OR=2.23, P<0.001) were positive corrected to AHI, the others indexes were not statistically corrected to AHI. Statistically significant differences of T90% were found in severe AHI group and the other groups (severe AHI group vs. normal/mild/moderate AHI group:18.8±16.4 vs. 0.1±0.5/1.7±5.8/2.9±3.8, F=35.40, P<0.001). T90% and the ratio of total apnea time to sleep time were associated with 10-year ASCVD risk in obstructive sleep apnea-hypopnea syndrome patients (T90%: OR=1.15, P=0.001; total apnea time to sleep time: OR=1.09, P=0.013). Conclusion: The ratio of overnight oxygen saturation below 90% and total apnea time to test time ratio can be suggested as all-night evaluation indexes and indicator factors for ASCVD risk of obstructive sleep apnea-hypopnea syndrome patients.

Key words: Sleep apnea syndromes, Monitoring, ambulatory, Risk assessment, Cardiovascular diseases

CLC Number:

R563.8

Zeng Wenmei, Wu Sulong, Liu Zhuofan, Yuan Long, Chen Bilin, Rong Yan. Analysis of all-night evaluation indexes and predictors of cardiovascular risk in patients with obstructive sleep apnea-hypopnea syndrome[J]. Journal of Tuberculosis and Lung Disease , 2025, 6(1): 1-7. doi: 10.19983/j.issn.2096-8493.2024132

Figures/Tables 6

临床资料	轻度组(45例)	中度组(58例)	重度组(76例)
性别[例(构成比,%)]
男性	34(75.6)	50(86.2)	67(88.2)
女性	11(24.4)	8(13.8)	9(11.8)
中位年龄[岁,M(Q₁,Q₃)]	45(35.8,58.3)	45(36.0,51.0)	48(41.0,55.8)
颈围(cm, $x ˉ$ ±s)
男性	41.0±2.5	40.6±3.7	42.5±2.6
女性	38.5±2.6	35.4±1.7	36.8±2.6
BMI( $x ˉ$ ±s)
男性	26.0±3.2	26.7±3.7	27.5±4.0
女性	26.7±2.9	24.5±2.3	26.9±3.0
AHI( $x ˉ$ ±s)
男性	10.3±2.8	20.4±3.9	48.5±14.8
女性	9.3±2.6	23.4±5.7	48.6±12.3
ESS(分, $x ˉ$ ±s)	4.4±2.3	8.5±2.8	13.7±3.0

指标	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
最低血氧饱和度	―0.173	0.055	10.015	0.002	0.84	0.76~0.94
整夜血氧饱和度低于90%时间比	―0.105	0.059	3.178	0.075	0.90	0.80~1.01
平均血氧饱和度	―0.141	0.113	1.559	0.212	0.87	0.70~1.08
最长暂停时间	―0.040	0.017	5.737	0.017	0.96	0.93~0.99
最长低通气时间	―0.020	0.013	2.471	0.116	0.98	0.96~1.01
整夜阻塞性呼吸暂停时间占睡眠时间比	0.639	0.099	41.350	<0.001	1.89	1.56~2.30
整夜低通气时间占睡眠时间比	0.803	0.129	38.821	<0.001	2.23	1.73~2.87
艾普沃斯嗜睡量表评分	―0.999	0.630	2.514	0.113	0.37	0.11~1.27

指标	低风险组(75例)	中风险组(47例)	高风险组(30例)
性别[例,构成比(%)]
男性	61(81.3)	42(89.4)	28(93.3)
女性	14(18.7)	5(10.6)	2(6.7)
年龄[岁,M(Q₁,Q₃)]	46(38,57)	47(41,54)	47(40,55)
腰围(cm, $x ˉ$ ±s)	90.4±9.8	93.7±10.7	95.8±10.3
糖尿病[例,发生率(%)]	3(4.0)	8(17.0)	6(20.0)
高血压[例,发生率(%)]	21(28.0)	30(63.8)	23(76.7)
目前吸烟[例,发生率(%)]	20(26.7)	19(40.4)	15(50.0)
心脑血管病家族史[例,发生率(%)]	1(1.3)	3(6.4)	2(6.7)

指标	低风险组(75例)	中风险组(47例)	高风险组(30例)	F值	P值
睡眠呼吸暂停低通气指数(次/h, $x ˉ$ ±s)	18.4±9.9	34.2±12.9	53.8±17.4	87.70	<0.001
最长暂停时间(s, $x ˉ$ ±s)	45.4±17.2	66.4±22.9	81.0±21.1	39.10	<0.001
最长低通气时间(s, $x ˉ$ ±s)	55.8±17.3	59.8±17.7	53.8±18.4	1.23	0.334
整夜暂停时间占睡眠时间比(%, $x ˉ$ ±s)	5.4±4.4	21.3±11.7	41.0±18.1	121.39	<0.001
整夜低通气时间占睡眠时间比(%, $x ˉ$ ±s)	5.8±4.6	4.6±3.5	4.4±5.9	1.42	0.048
整夜暂停及低通气总时间占睡眠时间比(%, $x ˉ$ ±s)	11.1±6.4	25.9±11.6	45.4±15.0	122.80	<0.001
最低血氧饱和度(%, $x ˉ$ ±s)	82.7±6.1	72.4±9.9	63.9±10.0	60.70	0.231
整夜血氧饱和度低于90%时间比( $x ˉ$ ±s)	1.9±2.5	11.1±9.7	28.3±3.3	80.10	<0.001
平均血氧饱和度(%, $x ˉ$ ±s)	94.3±2.3	93.3±2.0	90.0±3.2	25.60	0.327

分类	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
ASCVD中风险	18.649	16.645	1.255	0.263	125684736.60	―13.97~51.27
ASCVD高风险	22.673	16.717	1.839	0.175	7026684345.00	―10.09~55.44
整夜血氧饱和度低于90%时间比	0.142	0.043	11.053	0.001	1.15	1.06~1.25
平均血氧饱和度	0.165	0.180	0.838	0.360	1.17	0.83~1.68
最低血氧饱和度	―0.019	0.036	0.266	0.606	0.98	0.91~1.05
最长低通气时间	0.011	0.014	0.624	0.429	1.01	0.98~1.04
最长暂停时间	0.009	0.013	0.494	0.482	1.01	0.98~1.04
整夜暂停时间占睡眠时间比	0.083	0.033	6.130	0.013	1.09	1.02~1.16
整夜低通气时间占睡眠时间比	―0.058	0.057	1.024	0.312	0.94	0.84~1.06
AHI分级	0.795	0.449	3.136	0.077	2.22	0.92~5.34

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