Cluster Analysis And Study On Traditional Chinese Medicine Syndromes Of Hypertension Associated With OSAHS And Primary Aldosteronism

Purpose:The purpose of this study is to explore the TCM syndrome and its distribution characteristics of obstructive sleep apnea hypopnea syndrome Obstructive Sleep Apnea-Hypopnea Syndrome（OSAHS）complicated with primary aldosteronism Primary Aldosteronism（PA）associated hypertension,and to explore the correlation between different TCM syndrome types and aldosterone Aldosterone（ALD）and renin activity Plasma Renin Activity（PRA）.To provide objective basis for early intervention and treatment of clinical OSAHS complicated with PA-related hypertension.Methods:A total of 185 patients who met the diagnostic criteria of OSAHS and PA related hypertension in Yan’an Hospital of Kunming from November 2020 to January 2023 were selected.according to their general information and relevant laboratory indexes,the data collection table of OSAHS complicated with PA was compiled and filled in.On the day of admission,the symptoms,signs,tongue and pulse of the patients were collected,and the information table of the four diagnoses of traditional Chinese medicine was drawn and filled in.According to the four diagnostic information of traditional Chinese medicine collected from patients who meet the diagnostic criteria,it is introduced into SPSS26.0 for cluster analysis.According to the clear and reasonable classification of symptoms,the appropriate scale is selected to determine the syndrome group of patients with OSAHS complicated with PA-related hypertension,and then improve the general information name,sex,age,height,weight,Body Mass Index（BMI）,Epworth Sleepiness Scale（ESS）and laboratory indexes,Apena Hypopnen Index（AHI）,Lowest Biood Oxygen Saturation（LSaO₂）,ALD,PRA,ARR（ALD/PRA）,and then observe the correlation between each syndrome type and general information and above laboratory indexes to guide the clinic.Results:1.Basic information:the ratio of male to female in patients with OSAHS complicated with PA was 1.64,of which 115 were male,accounting for 62.1%,and 70were female,accounting for 37.9%,with an average age of 51.58±12.42.There were significant differences in age and BMI distribution between different genders.2.Through the cluster analysis of the four diagnostic information of traditional Chinese medicine,it was determined that the TCM syndrome types of OSAHS combined with PA were phlegm-dampness syndrome in 67 cases（36.2%）,spleen deficiency syndrome in 58 cases（34.1%）,qi stagnation and blood stasis syndrome in 31 cases（16.8%）,phlegm and blood stasis syndrome in 29 cases（15.6%）.According to the disease,it can be divided into 156 cases（65.9%）and 58 cases（34.1%）.3.There were significant differences in BMI and ESS scores among various syndrome types of OSAHS complicated with PA-related hypertension（p<0.0l）.No matter in the scores of BMI or ESS,there were significant differences between syndrome types and syndrome types（p<0.01）,phlegm and blood stasis syndrome>phlegm-dampness accumulation syndrome>qi stagnation and blood stasis syndrome>spleen.4.There was no significant difference in age among different syndrome types of OSAHS complicated with PA-related hypertension,but there was significant difference in AHI and LSaO₂among syndrome types（p<0.01）.In terms of AHI,phlegm and blood stasis syndrome>phlegm-dampness accumulation syndrome>qi stagnation and blood stasis syndrome>spleen deficiency syndrome.In terms of LSaO₂,only phlegm and blood stasis syndrome and spleen deficiency syndrome had statistical significance in pairwise comparison.There were statistically significant differences in aldosterone between all syndroms of OSAHS combined with PA-related hypertension（p<0.01）,and there were no statistically significant differences in plasma renin activity and ARR among all syndroms（p>0.05）.Pin-wise comparison showed no statistically significant differences between syndrome of accumulation of phlegm and dampness and syndrome of interformation of phlegm and blood stasis（p>0.05）.The difference was statistically significant（p<0.01）.5.There were significant differences in ALD among different syndrome types of OSAHS complicated with PA-related hypertension,but there was no significant difference in renin activity and ARR among different syndrome types.In the pairwise comparison between syndrome types,there was no significant difference between phlegm-dampness syndrome and phlegm-blood stasis syndrome,spleen deficiency syndrome and qi stagnation and blood stasis syndrome（p>0.05）,but phlegm-dampness syndrome and spleen deficiency syndrome;phlegm-dampness syndrome and spleen deficiency syndrome;phlegm-dampness syndrome and qi stagnation and blood stasis syndrome;there were significant differences between phlegm and blood stasis syndrome and qi stagnation and blood stasis syndrome（p<0.01）.6.The severity of hypertension associated with OSAHS complicated with PA was positively correlated with ALD（r_s=0.51,p<0.01）,but not with PRA and ARR（p>0.05）.There was a negative correlation between LSaO₂and ALD,and the correlation intensity was weak（r_s=-0.270,p<0.05）,but not with PRA and ARR（p>0.05）.Conclusion:1.There are more males than females in hypertension patients associated with 185case of OSAHS complicated with PA,and most of them are obese,middle-aged and elderly.2.TCM syndrome differentiation of hypertension patients associated with OSAHS and PA can be divided into four categories,namely excessive phlegm-dampness obstructing syndrome,spleen deficiency and no transport syndrome,Qi stagnation and blood stasis syndrome,and phlegm-stasis interjunction syndrome,mainly characterized by phlegm turbidity,water dampness and blood stasis,and manifested as deficiency syndrome and empirical evidence.Progress in the evolution of reality due to deficiency.3.TCM syndrome differentiation of patients with hypertension associated with OSAHS and PA shows that the syndrome of interjunction of phlegm and blood stasis and excessive accumulation of phlegm and dampness are mainly severe,the syndrome of spleen deficiency without transport is mainly mild to moderate,and the syndrome of qi stagnation and blood stasis is mainly moderate to severe.4.The severity of OSAHS complicated with PA-related hypertension was moderately positively correlated with ALD,but weakly positively correlated with PRS.There is a weak negative correlation between LSaO₂and ALD.