心脏内科住院患者阻塞性睡眠呼吸暂停低通气综合征的患病风险及预后的关系

摘要

目的：通过柏林问卷筛查心脏内科住院患者阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）的高危人群，评价 OSAHS 高危与心血管疾病患者预后的关系。方法选取2013年1月—2014年1月苏州大学附属第二医院心脏内科住院患者618例为研究对象，入院病情稳定后进行柏林问卷调查，根据评分将患者分为 OSAHS 高危组（≥2分，274例）和 OSAHS 低危组（≤1分，344例）。收集患者既往病史、现病史资料和随访1年后再住院、心因性死亡发生情况。结果 OSAHS 高危组年龄、颈围、体质量、体质指数（BMI）、身高校正的颈围、既往脑血管意外及高血压、糖尿病、高脂血症、慢性肾功能不全患病率高于 OSAHS 低危组（P ﹤0.05）。随访期间，OSAHS 高危组患者再住院70例（25.5％），OSAHS 低危组患者再住院52例（15.1％），OSAHS 高危组再住院率高于 OSAHS 低危组（χ2＝10.470，P ＝0.002）。OSAHS 高危组患者心因性死亡17例（6.2％），OSAHS 低危组患者心因性死亡4例（1.2％）， OSAHS 高危组心因性病死率高于 OSAHS 低危组（χ2＝11.810，P ＝0.001）。多因素 Logistic 回归分析结果显示，既往脑血管意外〔b ＝0.571，OR ＝1.763，95％ CI（1.017，3.085），P ＝0.045〕和高危 OSAHS〔b ＝0.560，OR ＝1.751，95％ CI（1.084，2.828），P ＝0.022〕是心脏内科住院患者再住院的危险因素；高危 OSAHS〔b ＝1.157，OR ＝3.182，95％ CI（1.045，9.687），P ＝0.042〕是心脏内科住院患者心因性死亡的危险因素。结论心血管疾病患者 OSAHS 高危人群合并高血压的比例较高，发生不良预后的风险增加。%Objective To investigate the relationship between high risk for obstructive sleep apnea hypopnea syndrome (OSAHS)and prognosis of patients with cardiovascular diseases,through the screening of high risk for OSAHS among cardiology department inpatients by Berlin questionnaire. Methods We enrolled 618 inpatients of the Department of Cardiology of the Second Affiliated Hospital of Soochow University from January 2013 to January 2014. After the illness got stable,the subjects were administrated with Berlin questionnaire. According to the scores,the subjects were divided into OSAHS high - risk group (≥2,n = 274)and OSAHS low - risk group( ≤1,n = 344). We collected data concerning medical history,history of present illness,readmission after one - year follow - up and psychogenic death. Results The high - risk group was higher(P﹤ 0. 05)than the low - risk group in age,neck circumference,body mass,BMI,neck circumference after height correction and the proportions of patients with previous cerebrovascular accidents, complicated hypertension, diabetes mellitus, hyperlipemia and chronic renal insufficiency. During the follow - up,70 (25. 5% )patients in high - risk group and 52 (15. 1% )patients in low - risk group were readmitted into the hospital,the high - risk group having higher readmission rate than the low - risk group(χ2 = 10. 470,P = 0. 002). Psychogenic death occurred in 17(6. 2% )patients in high - risk OSAHS group and 4(1. 2% )patients in low - risk group,the high - risk group having higher psychogenic mortality rate than low - risk group(χ2 = 11. 810,P = 0. 001). The multivariate Logistic regression analysis showed that previous cerebrovascular accidents〔b = 0. 571,OR = 1. 763,95% CI(1. 017,3. 085),P = 0. 045〕and high risk for OSAHS〔b = 0. 560,OR = 1. 751,95%CI(1. 084,2. 828),P = 0. 022〕were risk factors for the readmission of cardiology department inpatients;high risk for OSAHS〔b = 1. 157,OR = 3. 182,95% CI(1. 045,9. 687),P = 0. 042〕 were risk factors for psychogenic death of cardiology department inpatients. Conclusion Patients with cardiovascular diseases and high risk for OSAHS have higher incidence of complicated hypertension and higher risk in adverse prognosis.