| 1 Background Obstructive sleep apnea hypopnea syndrome(OSAHS) is a common disease of respiratory rhythm disorder encountered by the elderly. Because of the disturbance of ventilation,hyoxemia and sleep disorder caused by the disease, clinical symptoms like hypertension, arrhythmia,dizziness and so on. The latest guide of America pointed out that OSAHS is the primary cause of secondary hypertension. About 50%-90% of OSAHS patients complicated with hypertension in our country. At present the risk factor research of OSAHS associated with hypertension in the elderly is few, and most of the past research is about the single factor analysis, but the multi-factor analysis is not so much, especially the independent risk factors research has not been reported. The goal of this research is about the multi-factor analysis and clear related risk factors. 2 Objective To investigate the incidence of hypertension among elderly patients of OSAHS and associated risk factors. In this study, we further explored OSAHS associated hypertension, and provided evidences for preventing and formulating intervention measures. 3 Subjects and Method This study collected the cases of elderly patients with OSAHS that monitored by polysomnography(PSG) from May 2014 to December 2014 in the sleep monitoring center of The First Affiliated Hospital of Zhengzhou University. Finally, there are108 cases selected. Questionnaire survey、physical examination and polysomnography(PSG)were performed for all the elderly patients. Some indicators were monitored and recorded, such as blood pressure、lowest oxygen saturation、mean oxygen saturation、cumulative percentages of time spent at oxygen saturation below 90% and so on. According to the diagnostic criteria from《The clinical diagnosis and treatment of Obstructive sleep apnea associated with hypertension》 in 2012, there are 70 cases with hypertension(here in after referred to hypertension group). 38 cases without hypertension(non-hypertension group). SPSS 17.0 software was used for data analyzing. If the OSAHS associated with hypertension group in the elderly and non-hypertension group have constant variances, t test should be chosen, and express by-x ±s. If the OSAHS associated with hypertension group in the elderly and non-hypertension group have classified variances, chi-squared test should be chosen,and express by percentage. Then take with or without hypertension as the outcome variable to perform Logistic multiple regression analysis. The inspection level is 0.05. 4 Result ①In this research, there are 108 cases, including 70 cases with hypertension in the elderly, the incidence is 65%.②weight : x ±s in hypertension group was(78.65±12.484)Kg, non-hypertension group was(70.±11.753)Kg, t value was 3.197, P value was 0.003, it was statistically significant between the two groups; body mass index : x ±s in hypertension group was(28.541±4.015)Kg/m2, non-hypertension was(26.013±3.632)Kg/m2, t value was 3.326, P value was 0.001, it was statistically significant between the two groups; neck circumference : x ±s in hypertension group was(40.914±4.279)cm, non-hypertension group was(39.121±3.724)cm, t value was 2.265, P value was 0.026, it was statistically significant between the two groups; waist circumference: x ±s in hypertension group was(104.092±9.841)cm, non-hypertension group was( 98.881±13.465)cm, t value was 2.101, P value was 0.04, it was statistically significant between the two groups; apnea hypopnea index: x ±s in hypertension group was(41.251±22.521)time/h, non-hypertension was(32.210±22.208)time/h, t value was 2.131, P value was 0.036, it was statistically significant between the two groups; lowest oxygen saturation : x ±s in hypertension group was(70.786±14.771)%, non-hypertension group was(77.105±8.516)%, t value was-2.424, P value was 0.017, it was statistically significant between the two groups; mean oxygen saturation : x ±s in hypertension group was(92.490±3.340)%, non-hypertension group was(93.70±1.900)%, t value was 2.066, P value was 0.041, it was statistically significant between the two groups; CT90% : x ±s in hypertension group was(17.465±19.457)%, non-hypertension was(10.110±12.849)%, t value was 2.355, P value was 0.020, it was statistically significant between the two groups; oxygen desaturation index : x ±s in hypertension group was(28.857±21.652)%, non-hypertension was(37.704±21.615)%, t value was 2.029, P value was 0.046, it was statistically significant between the two groups; microarousal index : x ±s in hypertension group was(25.915±17.239)time/h, non-hypertension was(18.495±16.756)time/h, t value was 2.175, P value was 0.033, it was statistically significant between the two groups; the total time for apnea : x ±s in hypertension group was(129.060±61.103)minute, non-hypertension group was(99.450±71.656)minute, t value was 2.157, P value was 0.035, it was statistically significant between the two groups; the longest time of apnea : x ±s in hypertension group was(66.880±22.363)s, non-hypertension group was(54.370±24.557)s, t value was 2.609, P value was 0.011, it was statistically significant differences between the two groups; Smoking history:in hypertension group was 51.4%, non-hypertension group was 28.9%, it was statistically significant differences between the two groups(χ2 =5.064,P=0.024); mandibular retrusion:in hypertension group was 61.4%, non-hypertension group was 28.9%, it was statistically significant differences between the two groups(χ2 =10.394,P=0.001); tongue body hypertrophy : in hypertension group was 64.3%, non-hypertension group was 42.1%, it was statistically significant differences between the two groups(χ2 =4.930, P=0.026); uvula too wide: in hypertension group was 32.9%, non-hypertension group was 10.5%, it was statistically significant differences between the two groups(χ2 =6.550,P=0.010); uvula too long: in hypertension group was 34.3%, non-hypertension group was 15.8%, it was statistically significant differences between the two groups(χ2 =4.200,P=0.040); the sleepiness: in hypertension group was 87.1%, non-hypertension group was 60.5%, it was statistically significant differences between the two groups(χ2 =10.095,P=0.001). ③Gender 、Height 、N1%、N2%、N3%、R% were not statistically significant between the two groups(P value was greater than 0.05). ④Use hypertension as a final outcome variables, smoking history、body mass index、neck circumference、waist circumferencemandibular retrusion、tongue body hypertrophy、uvula too wide、uvula too long 、the sleepiness、weight、BMI、AHI、CT90%、oxygen desaturation index、microarousal index 、the longest time of apnea、the total time for apnea、Lowest oxygen saturation、mean oxygen saturation as independent variables to performed logistic multiple regression analysis showed that smoking history、 the sleepiness 、body mass index and mandibular retrusion as variable were accepted in the model, P values were 0.033、0.006、0.017、0.009, OR values were 2.903、4.688、1.175、3.622, there were risk factors for OSAHS associated hypertension of elderly. so they were independent risk factors for OSAHS associated hypertension of elderly. 5 Conclusion The incidence of OSAHS associated hypertension of elderly is high, and it was related with smoking history 、 body mass index 、 neck circumference 、 waist circumferencemandibular retrusion、tongue body hypertrophy、uvula too wide、uvula too long 、the sleepiness、weight、BMI、AHI、CT90%、oxygen desaturation index、microarousal index 、the longest time of apnea、the total time for apnea、Lowest oxygen saturation、mean oxygen saturation.Smoking history、sleepiness、body mass index and mandibular retrusion were independent risk factors for OSAHS associated hypertension of elderly, can be used as clinical evaluation of the risk of OSAHS associated hypertension of elderly. |
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