中国全科医学 ›› 2026, Vol. 29 ›› Issue (19): 2656-2663.DOI: 10.12114/j.issn.1007-9572.2025.0404

• 论著 • 上一篇    下一篇

基于低通气/呼吸暂停比值分型的阻塞性睡眠呼吸暂停患者心脏结构功能对比研究

秦浛, 杨梅, 刘英存, 刘雅贞, 谢俊豪, 陈小洁, 刘娟*()   

  1. 400042 重庆市,陆军军医大学大坪医院全科医学科
  • 收稿日期:2025-06-15 修回日期:2025-11-23 出版日期:2026-07-05 发布日期:2026-06-05
  • 通讯作者: 刘娟

  • 作者贡献:

    秦浛提出研究思路,负责研究的构思与设计,进行数据收集、统计学分析、绘制图表及撰写论文;杨梅进行数据的收集与整理,论文的修订;刘英存、刘雅贞进行数据的清洗,研究的可行性分析及论文的修订;谢俊豪、陈小洁进行数据收集与质控,研究结果的解释;刘娟负责文章的质量控制及审查,对文章整体负责,监督管理。

  • 基金资助:
    重庆市自然科学基金重点资助项目(CSTB2023NSCQ-ZDJ0009)

Comparative Study of Cardiac Structure and Function in Obstructive Sleep Apnea Patients Based on the Classification of Hypopnea/Apnea Ratio

QIN Han, YANG Mei, LIU Yingcun, LIU Yazhen, XIE Junhao, CHEN Xiaojie, LIU Juan*()   

  1. Department of General Practice, Daping Hospital, Army Medical University, Chongqing 400042, China
  • Received:2025-06-15 Revised:2025-11-23 Published:2026-07-05 Online:2026-06-05
  • Contact: LIU Juan

摘要: 背景 阻塞性睡眠呼吸暂停(OSA)可出现心脏结构重塑和功能受损,目前研究多集中于整体OSA人群,而较少关注低通气与呼吸暂停事件的不同分布类型对心脏结构和功能的影响。 目的 对比分析不同低通气/呼吸暂停比值(HAR)分型对OSA患者心脏结构功能的影响。 方法 选取2023年1月—2025年2月在陆军军医大学大坪医院全科医学科诊断为OSA并同期完善超声心动图住院患者193例,同时选择非OSA患者44例作为对照。根据HAR将OSA患者分为呼吸暂停为主型(n=66)和低通气为主型(n=127)。根据睡眠呼吸暂停低通气指数(AHI)分为轻度OSA组(n=68)、中度OSA组(n=73)、重度OSA组(n=52)。收集研究对象的一般资料、合并症、睡眠呼吸监测参数、超声心动图等,观察不同HAR分型对OSA患者心脏结构功能的影响。 结果 呼吸暂停为主型的OSA左心房收缩末期前后径(LADs)、左心室舒张末期前后径(LVDd)、右心房收缩末期横径(RADs)、收缩末期主动脉窦部内径(AOAs)、收缩末期肺动脉中部内径(MPAs)、舒张末期室间隔厚度(IVSTd)、舒张末期左心室后壁厚度(LVPWd)高于低通气为主型的OSA(P<0.05)。Spearman秩相关分析结果显示,OSA患者LADs、LVDd、RADs、AOAs、MPAs、IVSTd、LVPWd与AHI、氧减指数(ODI)呈正相关,与HAR呈负相关;最低血氧饱和度(LSpO2)与MPAs呈负相关;SpO2<90%的时间占总睡眠时间的百分比(T90)与LADs、LVDd、RADs、AOAs、MPAs呈正相关(P<0.05)。多元线性回归分析显示,在控制性别、年龄、BMI、AHI的影响后,OSA类型不是LADs、LVDd、RADs、AOAs、MPAs、IVSTd、LVPWd的影响因素(P>0.05),性别、年龄、BMI是多项心脏结构指标的影响因素(P<0.05),AHI是MPAs的独立影响因素(P<0.05)。 结论 低通气事件和呼吸暂停事件分布类型对OSA患者心脏结构功能无影响,性别、年龄、BMI、AHI可能是导致心脏重塑更重要的影响因素。

关键词: 睡眠呼吸暂停,阻塞性, 呼吸暂停, 超声心动图, 心脏功能

Abstract:

Background

Obstructive sleep apnea (OSA) is associated with cardiac structural remodeling and functional impairment. Most studies have focused on the overall OSA population, with limited attention given to the impact of different distributions of hypopnea and apnea events on cardiac structure and function.

Objective

To compare the impact of different hypopnea/ apnea ratio (HAR) classifications on cardiac structure and function in patients with OSA.

Methods

A retrospective analysis was conducted on 193 hospitalized patients with OSA and 44 control subjects at the Department of General Practice, Daping Hospital, Army Medical University from January 2023 to February 2025. All participants underwent comprehensive echocardiography during the same period. Based on the HAR, OSA patients were classified into apnea-dominant (n=66) and hypopnea-dominant (n=127) groups. They were also divided into mild (n=68), moderate (n=73), and severe (n=52) OSA groups according to the apnea hypopnea index (AHI). General demographics, comorbidities, sleep monitor parameters, and echocardiography data were collected to analyze the impact of different HAR classifications on cardiac structure and function in patients with OSA.

Results

Left atrial systolic diameter (LADs), left ventricular diastolic diameter (LVDd), right atrial systolic diameter (RADs), aortic sinus diameter (AOAs), main pulmonary artery systolic diameter (MPAs), interventricular septum diastolic thickness (IVSTd), and left ventricular posterior wall diastolic thickness (LVPWd) were significantly higher in apnea-dominant OSA patients than those in hypopnea-dominant patients (P<0.05). Spearman correlation analysis revealed that in patients with OSA, LADs, LVDd, RADs, AOAs, MPAs, IVSTd, and LVPWd were positively correlated with AHI, and oxygen desaturation index (ODI), while negatively correlated with HAR. The lowest SpO2 (LSpO2) was negatively correlated with MPAs. The percentage of total sleep time with SpO2 <90% (T90) was positively correlated with LADs, LVDd, RADs, AOAs, and MPAs (P<0.05). Multiple linear regression analysis revealed that after adjusting for the effects of gender, age, BMI, and AHI, there were no significant differences in cardiac structural indicators between the two types of OSA. Gender, age, and BMI were significant predictors of multiple cardiac structural parameters (P<0.05), while AHI was identified as an independent predictor of MPAs (P<0.05).

Conclusion

The distribution patterns of hypopnea and apnea events show no difference in their impact on cardiac structure and function in OSA patients. Gender, age, BMI, and AHI may have more significant impacts on cardiac remodeling.

Key words: Sleep apnea, obstructive, Apnea, Echocardiogram, Cardiac function

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