Study On The Correlation Between Obstructive Sleep Apnea Hypopnea Syndrome Associated Hypertension And Insulin Resistance

Background and Objective:Obstructive sleep apnea hypopnea syndrome is a respiratory rhythm disorders disease with higher incidence.It is characterized by the repeated intermittent hypoxia,reoxygenation,carbon dioxide retention,sleep structure changes and micro arousal.As a result,OSAHS can cause damage to multiple organs and systems in the whole body.OSAHS is one of the common causes of secondary hypertension.In this study,the patients with OSAHS associated hypertension were studied to understand the level of their insulin resistance.The purpose of this study was to determine whether OSAHS associated hypertension patients would show more obvious insulin resistance level than those with simple hypertension,to further explore the relationship between OSAHS associated hypertension and insulin resistance,to understand the risk factors of IR in OSAHS associated hypertension patients,and to provide some valuable reference for early prevention and treatment of IR in patients with hypertension associated with OSAHS.Subjects and Method:During the period from September 2015 to February 2018,polysomnography was performed for patients in the sleep diagnosis and treatment center,The First Affiliated Hospital of Zhengzhou University.In the end,238 patients were diagnosed with OSAHS associated hypertension?as observation group?,46 patients were diagnosed with simple hypertension?as a control group?.Questionnaire survey,physical examination,PSG detection,fasting plasma glucose and fasting insulin were performed for all the sufferers,Some indicators were monitored and recorded,such as the patient's age,gender,smoking history,drinking history,height,weight,blood pressure,ESS score,AHI,LSaO₂,CT90%,oxygen desaturation index,MSaO₂ and the total time of apnea,at the same time,BMI and HOMA-IR were calculated and recorded.SPSS 19.0 software was used for data analyzing.The numerical variables was denoted by the mean±standard deviation(^?x±s)and the classification variable was represented by the rate?%?.First of all,the variables of the observation group and control group were analyzed to compare by using two independent sample t-test and chi-squared.then,the observation group was divided into mild-moderate OSAHS group and severe OSAHS group according to the severity of OSAHS,T-test and chi-squared was used to compare the variables of the two groups.finally,Multiple linear regression analysis was performed with HOMA-IR value as dependent variable.The test level was 0.05.Result:?1?The comparison of the clinical data and HOMA-IR value between the observation group and the control group:the BMI of the observation group was?28.794±4.382?Kg/?and the control group was?26.577±2.697?Kg/?,while the difference between the two groups was statistically significant?t=4.537,P=0.000?;The ESS score of the observation group was?11.710±5.155?and the control group was?7.348±4.600?,while the difference between the two groups was statistically significant?t=5.341,P=0.000?;The fasting plasma glucose of the observation group was?5.225±1.009?mmol/L,the control group was?4.836±0.768?mmol/L,while difference between the two groups was statistically significant?t=2.971,P=0.004?;The HOMA-IR value of the observation group was?2.225±1.236?,the control group was?1.659±0.919?,while difference between the two groups was statistically significant?t=3.595,P=0.001?.Age,smoking history,drinking history,systolic blood pressure and diastolic blood pressure were not statistically significant.?2?The observation group was divided into mild-moderate OSAHS group and severe OSAHS group according to the severity of OSAHS,the comparison of the clinical data and HOMA-IR value between the two groups:the BMI of the severe OSAHS group was?30.113±4.801?Kg/?and the mild-moderate OSAHS group was?27.560±3.548?Kg/?,while the differences between the two groups was statistically significant?t=4.640,P=0.000?;The ESS score of the severe OSAHS group was?13.017±5.362?and the mild-moderate OSAHS group was?10.488±4.652?,while the difference between the two groups was statistically significant?t=3.894,P=0.000?;The fasting plasma glucose of the severe OSAHS group was?5.424±1.041?mmol/L and the mild-moderate OSAHS group was?5.038±0.942?mmol/L,while the difference between the two groups was statistically significant?t=3.005,P=0.003?;The HOMA-IR value of the severe OSAHS group was?2.632±1.353?and the mild-moderate OSAHS group was?1.844±0.975?,while the difference between the two groups was statistically significant?t=5.127,P=0.000?.Age,smoking history,drinking history,systolic blood pressure and diastolic blood pressure were not statistically significant.?3?The comparison of PSG results between the severe OSAHS group and mild-moderate group:the AHI of the severe OSAHS group was?66.600±22.570?/hour and the mild-moderate was?15.904±7.304?/hour,while the difference between the two groups was statistically significant?t=22.988,P=0.000?;the LSaO₂ of the severe OSAHS group was?65.128±12.112?%and the mild-moderate OSAHS group was?80.611±7.085?%,while the difference between the two groups was statistically significant?t=-11.933,P=0.000?;the CT90%of the severe OSAHS group was?34.448±24.583?%and the mild-moderate OSAHS group was?3.227±2.040?%,while the difference between the two groups was statistically significant?t=13.130,P=0.000?;The oxygen reduction index of the severe OSAHS group was?45.557±27.300?/hourandthemild-moderateOSAHSgroupwas?18.686±17.249?/hour,while the difference between the two groups was statistically significant?t=9.008,P=0.000?;The MSaO₂ of the severe OSAHS group was?89.784±5.383?%and the mild-moderate OSAHS group was?93.885±3.831?%,while the difference between the two groups was statistically significant?t=-6.729,P=0.000?;the total time of apnea of the severe OSAHS group was?158.694±88.504?min and the mild-moderate OSAHS group was?21.391±18.821?min,while the difference between the two groups was statistically significant?t=16.296,P=0.000?.?4?With HOMA-IR as the dependent variable,multiple linear regression was performed using BMI,ESS score,AHI,LSaO₂,CT90%,oxygen reduction index,MSaO₂ and the total time of apnea as independent variable.Then,multiple linear regression analysis results showed that ESS score,LSaO₂,CT90%,oxygen reduction index and the total time of apnea were excluded from the model,while BMI,AHI,and MSaO₂ entered the model,the P values were 0.000,0.001,0.047 and the standardized coefficients were 0.296,0.230,-0.133 respectively.Conclusion:1.OSAHS associated hypertension was more likely to cause insulin resistance than simple hypertensive patients.2.Patients with severe OSAHS associated hypertension likely showed a higher level of insulin resistance in patients with mild-moderate OSAHS associated hypertension.3.BMI,AHI,MSaO₂ were the significant factors influencing OSAHS associated hypertension.