Risk Factors For Carotid Atherosclerotic Lesions In Patients With Sleep Apnea Hypopnea Syndrome:A Clinical Research

Background:Among the middle and senior people,cardio-cerebrovascular diseases(CCBVDs)are common diseases,of which the incidence is increasing year by year.Atherosclerosis is one of the important causes of CCBVDs,and carotid artery is one predilection site of atherosclerosis.Multiple studies have confirmed that the formation of carotid atherosclerosis and plaques is affected by age,smoking,drinking,oxygen deprivation and many other factors.For the past few years,carotid intima media thickness(cIMT),which measured by color doppler ultrasound,has been proven to be highly repeatable and has a good relationship with traditional risk factors of CCBVDs.Sleep apnea hypopnea syndrome increases the morbidity and mortality of cardiovascular and CCVDs and carotid artery diseases,and the mechanism may be related to SAHS promoting the formation of carotid artery lesions,but the specific mechanism of SAHS in promoting carotid artery disease remains unclear.Objective:Using carotid ultrasound to evaluate carotid artery lesion(including cIMT thickening and carotid artery plaque formation),investigate the risk factors of cIMT and carotid artery plaque formation in SAHS patients without hypertension,diabetes mellitus,coronary heart disease and other cardiovascular complications.Methods:We screened SAHS patients in Qilu Hospital of Shandong University through January 1,2016 to September 30,2018.All of them accompanied by snoring,daytime sleepiness and other symptoms,have varying degrees of sleep apnea or hypopnea.After primary data collection(including gender,age,body mass index,family history,chronic medical conditions etc.),blood pressure and heart rate were measured for blood pressure management.Fasting venous blood was collected in the morning to test the metabolic parameters,and polysomnography was performed onthe same day.Philips iE33 Doppler diagnosis system was used to measure cIMT,and the number,size,location and echo intensity of carotid plaque.Pearson linear correlation analysis was performed to evaluate the correlation factors of carotid intimal thickness,further,the independent predictors of carotid intimal thickness were determined by multiple linear correlation regression analysis,and Independent risk factors for carotid artery plaque were assessed by logistic multivariate regression analysis.Results:1.1 A total of 316 patients were included in our study(301 males and 15 females,39.49±8.00 years),left cIMT 0.81±0.20mm,right cIMT 0.81±0.203mm.1.2 Correlation factors of left cIMT:age(r=0.356,P<0.001),systolic pressure(r=0.205,P<0.001),diastolic pressure(r=0.211,P<0.001),smoking(smoking per day X years)(r=0.157,P=0.005),quit smoking years(r=0.134,P=0.017),low density lipoprotein cholesterol(r=0.200,P<0.001),interventricular septal thickness(r=0.171,P=0.002),height(r=-0.166,P=0.003),total sleep time(r=0.119,P=0.034),total number of episodes of apnea and hypopnea(r=0.127,P=0.024),oxygen saturation<90%time(r=0.140,P=0.012),mean oxygen saturation(r=-0.134,P=0.019),lowest oxygen saturation(r=-0.129,P=0.022).1.3 Correlation factors of right cIMT:age(r=0.324,P<0.001),systolic pressure(r=0.,239,P<0.001),diastolic pressure(r=0.221,P<0.001),quit smoking years(r=0.133,P=0.018),low density lipoprotein cholesterol(r=0.213,P<0.001),interventricular septal thickness(r=0.183,P=0.001),right common carotid artery blood flow velocity(r=-0.111,P=0.049),height(r=-0.112,P=0.046),total number of episodes of apnea and hypopnea(r=0.115,P=0.042),oxygen saturation<90%time(r=0.118,P=0.036),mean oxygen saturation(r=-0.127,P=0.024).1.4 Independent predictors of left cIMT:age(?=0.367,P<0.001),low density lipoprotein cholesterol(?=0.183,P<0.001),systolic pressure(?=0.194,P<0.001),oxygen saturation<90%time(?=0.106,P=0.037).1.5 Independent predictors of right cIMT:age(?=0.328,P<0.001),systolic pressure(?=0.206,P<0.001),low density lipoprotein cholesterol(?=0.206,P<0.001),interventricular septal thickness(?=0.110,P=0.033).2.1 Among 316 patients,112 patients had unilateral or bilateral carotid plaques(35.4%),a total of 127 carotid plaques.There were 27 hypoechoic plaques(21.3%),14 medium-hypoechoic plaques(11.0%),55 moderate echo plaques(43.3%),2 medium and strong echo plaques(1.6%),19 strong echo plaques(15.0%),10 heterogeneous echo plaques(7.9%).2.2Independent risk factors for carotid plaque:age(OR 1.123,95%CI 1.067-1.181,P<0.001)?systolic pressure(OR 1.041,95%CI 1.001-1.082,P=0.044)?diastolic pressure(OR 1.104,95%CI 1.050-1.161,P<0.001)?hemoglobin(OR 0.974,95%CI 0.953-0.996,P=0.020)?triglyceride(OR 0.710,95%Cl 0.552-0.914,P=0.008)?low density lipoprotein cholesterol(OR 1.655,95%CI 1.103-2.483,P=0.015)?interventricular septal thickness(OR 1.248,95%CI 1.045-1.490,P=0.014).Conclusion:Among SAHS patients,cIMT was affected by a variety of factors.On one hand,left cIMT was affected by sleep apnea related factors,which did not significantly correlate with right cIMT.Carotid artery plaque formation was mainly affected'by age,blood pressure,hemoglobin,triglyceride,low density lipoprotein cholesterol,and interventricular septal thickness,and while,no significant correlation with sleep apnea.