阻塞性睡眠呼吸暂停患者夜间最低心率与脑小血管病之间的关联

文献信息

中文摘要

引言： 阻塞性睡眠呼吸暂停（OSA）通过涉及间歇性缺氧、自主神经失衡和代谢失调的机制被认为与脑小血管病（CSVD）有关，但其通路仍未得到充分阐明。这项回顾性观察性研究旨在识别与成人OSA患者CSVD相关的临床和生理因素。
方法： 我们回顾了2021年1月至2023年12月在广西壮族自治区人民医院睡眠医学科接受整夜多导睡眠监测并诊断为OSA的成年患者。收集的数据包括人口统计学资料、多导睡眠监测、生化标志物和脑MRI。主要结局为是否存在CSVD。多因素logistic回归确定独立因素，并使用受试者工作特征曲线下面积（AUC）评估模型区分度。
结果： 在630例患者中，265例（42%）患有CSVD。与无CSVD者相比，CSVD患者的NREM睡眠潜伏期更短、夜间觉醒次数更多，并具有独特的脂质谱，即LDL-C和ApoB较低，但HDL-C和ApoA1/B比值较高。多因素分析确定年龄较大（OR 1.095，95% CI 1.071-1.118，p < 0.001）和夜间最低心率较高（OR 1.023，95% CI 1.006-1.040，p = 0.008）与CSVD独立相关。该模型显示出良好的区分度（AUC 0.752）。
讨论： 夜间最低心率升高可能反映自主神经调节改变，与OSA中的CSVD独立相关。研究结果提示自主神经功能障碍和睡眠碎片化可能在该人群中促进CSVD的发病机制。

英文摘要

INTRODUCTION: Obstructive sleep apnea (OSA) has been implicated in cerebral small vessel disease (CSVD) through mechanisms involving intermittent hypoxia, autonomic imbalance, and metabolic dysregulation, but the pathways remain insufficiently elucidated. This retrospective observational study sought to identify clinical and physiological factors associated with CSVD in adults with OSA.
METHODS: We reviewed adult patients who underwent overnight polysomnography and were diagnosed with OSA at the Sleep Medicine Department of the People's Hospital of Guangxi Zhuang Autonomous Region from January 2021 to December 2023. Data collected included demographics, polysomnography, biochemical markers, and brain MRI. The primary outcome was the presence of CSVD. Multivariate logistic regression determined independent factors, and model discrimination was assessed with the area under the receiver operating characteristic curve (AUC).
RESULTS: Among 630 patients, 265 (42%) had CSVD. Compared with those without CSVD, patients with CSVD had shorter NREM sleep latency, more nocturnal awakenings, and a distinct lipid profile with lower LDL-C and ApoB, but higher HDL-C and ApoA1/B ratios. Multivariate analysis identified older age (OR 1.095, 95% CI 1.071-1.118, p < 0.001) and higher nocturnal minimum heart rate (OR 1.023, 95% CI 1.006-1.040, p = 0.008) as independently associated with CSVD. The model showed good discrimination (AUC 0.752).
DISCUSSION: Elevated nocturnal minimum heart rate, possibly reflecting altered autonomic regulation, was independently associated with CSVD in OSA. Findings suggest autonomic dysfunction and sleep fragmentation may contribute to CSVD pathogenesis in this population.