慢性阻塞性睡眠呼吸暂停综合征患者左室肥厚的性别差异
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摘要
目的:探讨慢性阻塞性睡眠呼吸暂停综合征(OSAS)患者的左室肥厚的性别差异。方法:回顾性分析2015年12月～2018年3月中日友好医院OSAS住院患者206例,多导睡眠图评估睡眠呼吸暂停严重程度,超声心动图评估左室肥厚及左室舒张功能,检测血清高敏肌钙蛋白(hsTNT)、血脂、血糖等指标。结果:OSAS患者中,男性的左室肥厚程度、收缩压及舒张压、血红蛋白水平、呼吸暂停低通气指数(AHI)、糖尿病、冠心病患病率均高于女性(均P<0.05);左室舒张功能低于女性(P<0.05);女性的hsTNT水平高于男性(P<0.01)。男性OSAS患者左室肥厚的主要预测因子是年龄、BMI、收缩压水平和AHI,女性则是hsTNT、收缩压水平、最低血氧饱和度水平以及处于绝经期。结论:OSAS患者中,男性的左室肥厚程度高于女性,左室舒张功能低于女性。
Objective:To investigate gender-specific differences on left ventricular hypertrophy and diastolic function in obstructive sleep apnea syndrome(OSAS)patients.Methods:We retrospectively collected clinical data of 206 patients with OSAS,including blood chemical results and hsTNT level.Echocardiography was performed to assess left ventricular hypertrophy and polysomnography was performed to evaluate severity of OSAS.Results:In all of the OSAS patients,the degree of LVH,systolic and diastolic pressure,HGB level,AHI,prevalence of diabetes and prevalence of coronary heart disease of male patients were higher than those of female patients(P<0.05,seperately).Males' left ventricular diastolic function were worse than that of females(P<0.05).Hs-TNT levels of females were higher than that of males(P<0.01).The independent predictors of LVH in male OSAS patients were age,BMI,systolic blood pressure and AHI,while the independent predictors of LVH in female OSAS patients were levels of hsTNT,systolic blood pressure,the lowest oxygen saturation and menopause.Conclusion:The degree of LVH in male OSA patients was higher than that of females.Males' left ventricular diastolic function was worse than that of females.
Objective:To investigate gender-specific differences on left ventricular hypertrophy and diastolic function in obstructive sleep apnea syndrome(OSAS)patients.Methods:We retrospectively collected clinical data of 206 patients with OSAS,including blood chemical results and hsTNT level.Echocardiography was performed to assess left ventricular hypertrophy and polysomnography was performed to evaluate severity of OSAS.Results:In all of the OSAS patients,the degree of LVH,systolic and diastolic pressure,HGB level,AHI,prevalence of diabetes and prevalence of coronary heart disease of male patients were higher than those of female patients(P<0.05,seperately).Males' left ventricular diastolic function were worse than that of females(P<0.05).Hs-TNT levels of females were higher than that of males(P<0.01).The independent predictors of LVH in male OSAS patients were age,BMI,systolic blood pressure and AHI,while the independent predictors of LVH in female OSAS patients were levels of hsTNT,systolic blood pressure,the lowest oxygen saturation and menopause.Conclusion:The degree of LVH in male OSA patients was higher than that of females.Males' left ventricular diastolic function was worse than that of females.
引文
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[11]Humphries KH,Izadnegahdar M,Sedlak T,et al.Sex differences in cardiovascular disease-Impact on care and outcomes[J].Front Neuroendocrinol,2017,46:46-70.
[12]Rattanasopa C,Phungphong S,Wattanapermpool J,et al.Significant role of estrogen in maintaining cardiac mitochondrial functions[J].J Steroid Biochem Mol Biol,2015,147:1-9.
[13]Yang Y,Wang IW,Turrentine M,et al.Postischemic application of estrogen ameliorates myocardial damage in an in?vivo mouse model[J].J Surg Res,2018,231:366-372.
[14]Rosano GM,Spoletini I,Vitale C.Cardiovascular disease in women,is it different to men?The role of sex hormones[J].Climacteric,2017,20(2):125-128.
[15]Dasinger JH,Alexander BT.Gender differences in developmental programming of cardiovascular diseases[J].Clin Sci(Lond),2016,130(5):337-348.
[16]Tantrakul V,Park CS,Guilleminault C.Sleep-disordered breathing in premenopausal women:Differences between younger(less than 30 years old)and older women[J].Sleep Med,2012,13(6):656-662.
[17]Sampaio R,Pereira MG,Winck JC.Psychological morbidity,illness representations,and quality of life in female and male patients with obstructive sleep apnea syndrome[J].Psychology Health&Medicine,2012,17(2):136-149.
[2]Floras JS.Sleep Apnea and cardiovascular disease:An enigmatic risk factor[J].Circ Res,2018,122(12):1741-1764.
[3]Ismail K,Roberts K,Manning P,et al.OSA and pulmonary hypertension:time for a new look[J].Chest,2015,147(3):847-861.
[4]洪作庚,欧琼.阻塞性睡眠呼吸暂停患者心血管功能早期损伤研究进展[J].中华医学杂志,2019,99(6):478-480.
[5]Jordan AS,Mcsharry DG,Malhotra A.Adult obstructive sleep apnoea[J].Lancet,2014,383(9918):736-747.
[6]高洁,王荣国,王立立.无创持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者心脏亚临床功能障碍的探究[J].中国循环杂志,2019,34(1):72-76.
[7]Campos-Rodriguez F,Queipo-Corona C,Carmona-Bernal C,et al.Continuous positive airway pressure improves quality of life in women with OSA.A Randomized-controlled Trial[J].Am J Respir Crit Care Med,2016,194(10):1286-1294.
[8]Chen Y,Zhang Z,Hu F,et al.17β-estradiol prevents cardiac diastolic dysfunction by stimulating mitochondrial function:a preclinical study in a mouse model of a human hypertrophic cardiomyopathy mutation[J].J Steroid Biochem Mol Biol,2015,147:92-102.
[9]吴莉,王继群,唐智,等.重度阻塞性睡眠呼吸暂停低通气综合征合并高血压对心脏结构和功能的影响[J].中国临床研究,2016,29(4):536-538.
[10]Williams B,Mancia G,Spiering W,et al.2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology:ESH/ESC Task Force for the Management of Arterial Hypertension[J].J Hypertens,2018,36(12):2284-2309.
[11]Humphries KH,Izadnegahdar M,Sedlak T,et al.Sex differences in cardiovascular disease-Impact on care and outcomes[J].Front Neuroendocrinol,2017,46:46-70.
[12]Rattanasopa C,Phungphong S,Wattanapermpool J,et al.Significant role of estrogen in maintaining cardiac mitochondrial functions[J].J Steroid Biochem Mol Biol,2015,147:1-9.
[13]Yang Y,Wang IW,Turrentine M,et al.Postischemic application of estrogen ameliorates myocardial damage in an in?vivo mouse model[J].J Surg Res,2018,231:366-372.
[14]Rosano GM,Spoletini I,Vitale C.Cardiovascular disease in women,is it different to men?The role of sex hormones[J].Climacteric,2017,20(2):125-128.
[15]Dasinger JH,Alexander BT.Gender differences in developmental programming of cardiovascular diseases[J].Clin Sci(Lond),2016,130(5):337-348.
[16]Tantrakul V,Park CS,Guilleminault C.Sleep-disordered breathing in premenopausal women:Differences between younger(less than 30 years old)and older women[J].Sleep Med,2012,13(6):656-662.
[17]Sampaio R,Pereira MG,Winck JC.Psychological morbidity,illness representations,and quality of life in female and male patients with obstructive sleep apnea syndrome[J].Psychology Health&Medicine,2012,17(2):136-149.