高血压患者阻塞性睡眠呼吸暂停低通气综合征严重程度与冠状动脉微循环功能的相关性

Association between severity of obstructive sleep apnea-hypopnea syndrome and coronary microvascular function in patients with hypertension

    摘要
  • 摘要:
    目的 探讨高血压患者阻塞性睡眠呼吸暂停低通气综合征（OSAHS）严重程度与冠状动脉微循环功能的相关性。
    方法 选取2024年9月至2025年9月在徐州市中心医院心内科住院收治的高血压患者262例，均完成便携式睡眠监测，并依据睡眠呼吸暂停低通气指数（AHI）将患者分为无OSAHS组(单纯高血压组，AHI＜5次/h)、轻度OSAHS组（AHI 5～＜15次/h）、中度OSAHS组(AHI 15～≤30次/h)、重度OSAHS组(AHI＞30次/h) 4组。为评估冠状动脉微循环功能，其中55例行心脏负荷超声心动图检查获取冠状动脉血流速度储备（CFVR），另224例行冠状动脉造影，采用定量血流分数（QFR）技术计算血管造影微循环阻力指数（AMR）。收集研究对象的临床资料、睡眠监测参数、CFVR、AMR及超敏C反应蛋白（hsCRP）、白细胞介素6（IL-6）等相关数据。采用多因素线性回归分析OSAHS严重程度与冠状动脉微循环功能的相关性。
    结果 与无OSAHS组、轻度OSAHS组及中度OSAHS组相比，重度OSAHS组的CFVR降低（1.80±0.19 比2.46±0.25、2.41±0.27、2.07±0.23，F=18.171，均P＜0.05），左前降支AMR增高（3.40±0.34）比（2.75±0.39）、（2.73±0.47）、（3.00±0.38）mmHg·s·cm−1，F=24.935，均P＜0.05。此外，重度OSAHS组的左回旋支AMR、IL-6及hsCRP水平亦高于其他各组（均P＜0.05）。与无OSAHS组及轻度OSAHS组相比，中度OSAHS组的CFVR降低，而其左前降支AMR、左回旋支AMR和IL-6水平均升高（P＜0.05）。多因素线性回归分析显示，OSAHS严重程度增加是CFVR降低（B = –0.234，P＜0.001）和左前降支AMR升高（B = 0.217，P＜0.001）的独立影响因素。
    结论 在高血压患者中，合并中重度OSAHS与更严重的冠状动脉微循环功能障碍相关，且功能障碍的严重程度随OSAHS等级增加而加重。

     

    Abstract:
    Objective To investigate the association between the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) and coronary microvascular function in patients with hypertension.
    Methods A total of 262 hypertensive patients hospitalized in the Department of Cardiology, Xuzhou Central Hospital from September 2024 to September 2025 were enrolled. All patients underwent portable sleep monitoring. Based on the apnea-hypopnea index (AHI), patients were divided into four groups: without OSAHS group (AHI＜5 events/hour), mild OSAHS group ( AHI 5 to ＜15 events/hour), moderate OSAHS group (AHI 15 to≤30 events/hour), and severe OSAHS group (AHI＞30 events/hour). To assess coronary microcirculatory function, coronary flow velocity reserve (CFVR) was obtained via stress echocardiography in 55 patients, and the angiographic microcirculatory resistance index (AMR) was calculated using quantitative flow ratio (QFR) technology based on coronary angiography in 224 patients. Clinical data, sleep monitoring parameters, CFVR, AMR, and relevant laboratory data including high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were collected. Multivariate linear regression analysis was performed to assess the association between OSAHS severity and coronary microvascular function.
    Results  Compared with without OSAHS group, mild OSAHS group, and moderate OSAHS group, in the severe OSAHS group, CFVR was significantly lower (1.80±0.19 vs 2.46±0.25, 2.41±0.27, 2.07±0.23,F=18.171,all P＜0.05), and the left anterior descending artery AMR was significantly higher (3.40±0.34 vs 2.75±0.39, 2.73±0.47, 3.00±0.38 mmHg·s·cm-1, F=24.935,all P＜0.05). Furthermore, the left circumflex artery AMR, IL-6, and hsCRP levels in the severe OSAHS group were also significantly higher than those in the other groups (P＜0.05). Compared with the without OSAHS and mild OSAHS groups, the moderate OSAHS group showed a significantly lower CFVR, while its left anterior descending artery AMR, left circumflex artery AMR, and IL-6 levels were significantly elevated (P＜0.05). Multivariate linear regression analysis revealed that increased OSAHS severity was an independent predictor of decreased CFVR (B = –0.234, P＜0.001) and increased left anterior descending artery AMR (B = 0.217, P＜0.001).
    Conclusion Among hypertensive patients, comorbid moderate-to-severe OSAHS is associated with more severe coronary microcirculatory dysfunction, and the severity of this dysfunction increases with the grade of OSAHS.

     

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