Changes Of Serum Hypoxia-inducible Factor-1α,Homocysteine And C-reactive Protein In Patients With Obstructive Sleep Apnea Hypopnea Syndrome And Hypertension And Their Predictive Value For Diagnosis

Objective Detecting the variance of serum Hypoxia-Inducible Factor-1α（HIF-1α）,Homocysteine（Hcy）,C-Reactive Protein（CRP）to research their predictive values in diagnosis of Obstructive Sleep Apnea Hypopnea Syndrome（OSAHS）complicated with hypertension.Methods 1.247 patients treated in the First People’s Hospital of Kunshan Sleep Monitoring Center from January 2017 to December 2019 were included.By means of polysomnography（PSG）monitoring,196 patients were diagnosed with OSAHS,including94 cases of OSAHS with hypertension（Group OH）and 102 cases of simple OSAHS（Group O）.51 snore patients were divided into snore with hypertension（Group H,28 cases）and simple snore（Group N,23 cases）.2.Collecting general information,including age,gender,Body Mass Index（BMI）and neck circumference.3.Recording the main sleep parameters:Apnea Hypopnea Index（AHI）,Mean Peripheral Capillary Oxygen Saturation（MSp O₂）,Lowest Peripheral Capillary Oxygen Saturation（LSp O₂）,Percentage of Sleep Time with Sp O₂below 90%（TRTSp O₂<90%）.The Enzyme-Linked Immunosorbent Assay（ELISA）,enzymatic cycling assay and nephelometry were performed to determine the level of serum HIF-1α,Hcy and CRP respectively.4.Comparing the main sleep parameters,HIF-1α,Hcy and CRP among four groups.5.Analyzing the correlation of HIF-1α,Hcy,CRP and the main sleep parameters in OH group.6.Analyzing the correlation among HIF-1α,Hcy and CRP in OH group.7.Comparing the differences of HIF-1α,Hcy and CRP between 30 cases from Group O and 30 cases Group OH matched by gender,age,BMI and AHI.8.The Receiver Operating Characteristic curve（ROC curve）analysis method was used to analyze the area under the curve（AUC）of HIF-1α,Hcy,and CRP in the diagnosis of OSHAS complicated with hypertension and simple OSAHS.Identifying the advantages and disadvantages of each method to determine a feasible screening program.Results 1.General information:Among Group OH,O,H and N,age,male ratio,BMI and neck circumference decreased in turn.There were significant differences in age,gender,BMI and neck circumference among four groups（P<0.05）.Pairwise comparison:There were significant difference in gender between two groups（P<0.00833）except for Group N and H,Group H and O,Group O and OH（P≥0.00833）.There were significant difference in age,BMI and neck circumference between two groups（P<0.05）except for Group N and H,Group O and OH（P≥0.05）.2.AHI,TRTSp O₂<90%decreased while MSp O₂,LSp O₂ increased in turn and the differences of AHI,MSp O₂,LSp O₂,TRTSp O₂<90%among four groups were statistically significant（P<0.05）.Pairwise comparison:There were significant difference between two groups（P<0.05）except for Group N and H（P≥0.05）.3.HIF-1α,Hcy and CRP decreased in turn and there were significant differences among four groups（P<0.05）.Pairwise comparison:There were significant difference between two groups（P<0.05）except for Group N and H（P≥0.05）.4.In OH group,HIF-1α,Hcy,and CRP were positively correlated with AHI,TRTSp O₂<90%（P<0.05）,and negatively correlated with MSp O₂and LSp O₂（P<0.05）.5.There was a positive correlation between HIF-1αand Hcy in Group OH（P<0.05）and poor correlations（r<0.3）between HIF-1αand CRP,Hcy and CRP with statistically significant（P<0.05）.6.HIF-1α,Hcy,and CRP in 30 random cases from Group OH were higher than those in Group O,and the differences were all statistically significant（P<0.05）.7.The AUC of HIF-1α,Hcy for predicting OSHAS complicated with hypertension were more than 0.7（AUC=0.813,0.770）and the optimal cut-off values were 11.050ng/m L and 10.200 umol/L,respectively,both of which were useful for the diagnosis of OSAHS complicated with hypertension.Conclusions1.Serum HIF-1α,Hcy and CRP increase in OSAHS patients complicated with hypertension.2.Serum HIF-1α,Hcy and CRP are closely related to the main sleep parameters（including AHI,MSp O₂,LSp O₂,TRTSp O₂<90%）in OSAHS patients complicated with hypertension.3.Determination of serum HIF-1αand Hcy is useful for the diagnosis and prediction of OSAHS complicated with hypertension.