酒精对高血压肥胖人群阻塞性睡眠呼吸暂停综合征严重程度的影响分析

doi:10.12114/j.issn.1007-9572.2020.00.516

摘要/Abstract

摘要： 背景　饮酒会加重阻塞性睡眠呼吸暂停综合征（OSAS），且OSAS患者肺泡表面活性蛋白B（SP-B）与OSAS的严重程度呈负相关。但是，在高血压肥胖患者中，短期饮酒对于SP-B水平的影响尚不明确。目的　分析饮酒对高血压肥胖患者OSAS严重程度的影响以及相关的危险因素。方法　选取2015年4月—2016年9月就诊于新疆维吾尔自治区人民医院高血压中心年龄≥18岁的男性主诉饮酒后打鼾加重的高血压患者61例为研究对象，根据中国成年人超重和肥胖诊断标准，分为肥胖组31例〔体质指数（BMI）≥28 kg /m2〕与非肥胖组30例（BMI<28 kg /m2）。分别在患者饮酒前后进行两次睡眠呼吸监测（PSG），记录患者睡眠呼吸暂停低通气指数（AHI）、呼吸暂停指数（AI）、低通气指数（HI）、最低动脉血氧饱和度（LSaO2）、睡眠效率、睡眠1期、睡眠2期、睡眠3期、睡眠4期及快速眼球运动睡眠（REM）期等指标，测量其饮酒前后酒精浓度，并于饮酒前、饮酒后PSG前及饮酒后次日清晨抽取静脉血进行SP-B水平测定，同时监测PSG前及次日清晨血压水平。采用多因素Logistic回归分析探讨饮酒后LSaO2降低的影响因素。结果　肥胖组饮酒后LSaO2、REM期、睡前收缩压、晨起舒张压低于饮酒前，酒精浓度高于饮酒前（P<0.05）；非肥胖组饮酒后酒精浓度、AHI、AI、HI高于饮酒前，LSaO2低于饮酒前（P<0.05）。肥胖组患者饮酒后PSG前SP-B水平低于饮酒后次日（P<0.05）。多因素Logistic回归分析结果显示，饮酒后低SP-B水平〔OR=5.512，95%CI（1.101，27.609）〕是LSaO2降低的危险因素。结论　饮酒会影响肥胖高血压患者OSAS严重程度以及SP-B水平，单次酒精摄入可能会通过降低SP-B和LSaO2水平，加重高血压肥胖人群中OSAS患者的病情。

关键词: 高血压；睡眠呼吸暂停, 阻塞性；肥胖；酒精；肺泡表面活性蛋白B；影响因素分析

Abstract: Background　Alcohol consumption can exacerbate the severity of obstructive sleep apnea syndrome（OSAS），but serum surfactant protein B（SP-B）is negatively correlated with OSAS severity.However，the short-term effect of alcohol consumption on serum SP-B is not clear in obese hypertensive patients.Objective　To analyze the impact of alcohol consumption on the severity of OSAS and related risk factors in obese hypertensive patients.Methods　Sixty-one adult male hypertensive patients（≥18 years）with complaints of severe snoring after drinking who were treated in Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region due to chief complaints of severe snoring after drinking from April 2015 to September 2016 were selected，including 31 obese ones（obesity group，BMI ≥ 28 kg/m2）and 30 non-obese ones（non-obesity group，BMI <28 kg/m2）stratified by the Diagnostic Criteria for Overweight and Obesity in Chinese Adults.Polysomnography（PSG）was monitored twice before and after alcohol consumption，respectively，recording indicators such as apnea-hypopnea index（AHI），apnea index（AI），hypopnea index（HI），lowest saturation of oxygen（LSaO2），sleep efficiency，sleep stage 1，sleep stage 2，sleep stage 3，sleep stage 4，REM period and other indicators.The alcohol concentration was measured before and after drinking.The venous blood sample was collected before drinking，after drinking but before PSG，and the following morning after drinking to determine the concentration of SP-B.At the same time，blood pressure levels were monitored before and after PSG as well as the following morning after drinking.Multivariate Logistic regression analysis was used to explore the influencing factors of decreased LSaO2 after drinking.Results　After alcohol consumption，in the obese group，the LSaO2，REM period，pre-bedtime systolic blood pressure，and morning diastolic blood pressure decreased significantly but blood alcohol concentration increased significantly after alcohol consumption（P<0.05），while in the non-obese group，the blood alcohol concentration，AHI，AI，and HI increased significantly but LSaO2 decreased notably（P<0.05）.SP-B concentration monitored after alcohol consumption but before PSG decreased significantly at the next morning in the obese ones（P<0.05）.Multivariate Logistic regression analysis showed that low serum SP-B concentration after alcohol consumption〔OR=5.512，95%CI（1.101，27.609）〕 was a risk factor for the decrease of LSaO2.Conclusion　Drinking can affect the severity of OSAS and the level of SP-B in obese hypertensive population.Single alcohol intake may aggravate the illness of OSAS in obese hypertensive population by reducing serum SP-B concentration and LSaO2.

Key words: Hypertension；Sleep apnea, obstructive；Obesity；Alcohol；Alveolar surfactant protein B；Root cause analysis

王瑛,姚晓光,洪静,等. 酒精对高血压肥胖人群阻塞性睡眠呼吸暂停综合征严重程度的影响分析[J]. 中国全科医学, 2020, 23(32): 4085-4090. DOI: 10.12114/j.issn.1007-9572.2020.00.516.
WANG Ying,YAO Xiaoguang,HONG Jing, et al. An Investigation of Alcohol Consumption Affecting OSAS Severity in Obese Hypertensive Population　[J]. Chinese General Practice, 2020, 23(32): 4085-4090. DOI: 10.12114/j.issn.1007-9572.2020.00.516.

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