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Article(id=1240972417099690357, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202402190, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1707667200000, receivedDateStr=2024-02-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800480389, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800480389, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800480389, creator=13701087609, updateTime=1773800480389, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1724, endPage=1728, ext={EN=ArticleExt(id=1240972417368125836, articleId=1240972417099690357, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effects of obstructive sleep apnea and obesity on nocturnal blood pressure, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between obstructive sleep apnea (OSA) and nocturnal blood pressure, and to evaluate the possible effect of obesity in this association, so as to provide reference for further exploring the mechanism of OSA-related hypertension.

Methods

A total of 753 adult patients diagnosed with OSA were randomly selected from August 2021 to December 2022 in the Sleep Medicine Center of the Fourth West China Hospital of Sichuan University because of snoring, apnea, and other reasons. After polysomnography (PSG) was completed, 753 adult patients diagnosed with OSA were selected as research subjects. The general data of patients, PSG related data, nocturnal blood pressure and related indicators were collected. Correlation analysis and structural equation model were used to analyze the effects of OSA and obesity on nocturnal blood pressure.

Results

In patients with OSA, Apnea Hyponea Index (AHI) was positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP) (r=0.297 and 0.222, P < 0.001), and BMI (r=0.443, P < 0.001), and BMI was positively correlated with SBP and DBP (r=0.313 and 0.260, P < 0.001). The results of structural equation model suggested that obesity played an intermediary role in the effect of OSA on nocturnal SBP and DBP. The standardized intermediary effect values were 0.063 (95%CI: 0.035-0.090) and 0.059 (95%CI: 0.032-0.087), respectively, and the proportion of intermediary effect was 21.72% and 26.22%, respectively.

Conclusion

OSA can directly affect the blood pressure of patients. At the same time, obesity plays an intermediary role in the effect of OSA on SBP and DBP.

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目的

分析阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）与夜间血压的关系，并对肥胖在这种联系中的可能效应进行评价，为进一步探索OSA相关高血压的发生机制研究提供基础。

方法

随机选取2021年8月—2022年12月于四川大学华西第四医院睡眠医学中心，因“打鼾、呼吸暂停”等原因就诊，且均完成多导睡眠监测（polysomnography，PSG）后，诊断为OSA的753例成人患者作为研究对象。收集患者一般资料、PSG相关数据、夜间血压相关指标等。采用相关分析、结构方程模型，分析OSA和肥胖对夜间血压的影响作用。

结果

OSA患者AHI和平均收缩压（SBP）、平均舒张压（DBP）均呈正相关（r=0.297、0.222，P<0.001），与BMI呈正相关（r=0.443，P<0.001)；BMI和SBP、DBP呈正相关（r=0.313、0.260，P<0.001）。结构方程模型结果提示，肥胖在OSA对夜间SBP、DBP的影响中存在中介作用。标准化中介效应值分别为0.063（95%CI：0.035～0.090）、0.059（95%CI：0.032～0.087）；中介效应占比分别为21.72%、26.22%。

结论

OSA可直接影响患者血压，与此同时肥胖在OSA对SBP、DBP的影响中存在中介作用。

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张晓晴，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=HIZyNbOH6wmXDQ0CiXQ2aQ==, magXml=ZFNV5aXJ3a5G3v4JAysTGw==, pdfUrl=null, pdf=CPM3vU31iBqXJ+2weX1L3g==, pdfFileSize=671322, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=m1paOO2/20aWonCvY+drsw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=MG6BeyTHfBWiQsaZBfn4jg==, mapNumber=null, authorCompany=null, fund=null, authors=

李婉姝（1998—），女，硕士在读，研究方向：劳动卫生与环境卫生

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李婉姝（1998—），女，硕士在读，研究方向：劳动卫生与环境卫生

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Journal of Clinical Endocrinology &Metabolism, 2024, 109(3): e1267-e1279., articleTitle=Approach the patient with obstructive sleep apnea and obesity, refAbstract=null), Reference(id=1240986275512119303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, doi=null, pmid=null, pmcid=null, year=2015, volume=31, issue=7, pageStart=853, pageEnd=859, url=null, language=null, rfNumber=[17], rfOrder=20, authorNames=Huang ZW, Liu ZH, Luo Q, journalName=Canadian Journal of Cardiology, refType=null, unstructuredReference=Huang ZW, Liu ZH, Luo Q, et al. Predictors of blood pressure fall with continuous positive airway pressure treatment in hypertension with coronary artery disease and obstructive sleep apnea[J]. Canadian Journal of Cardiology, 2015, 31(7): 853-859., articleTitle=Predictors of blood pressure fall with continuous positive airway pressure treatment in hypertension with coronary artery disease and obstructive sleep apnea, refAbstract=null)], funds=[Fund(id=1240986270671893412, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, awardId=2021YFH0165；, language=CN, fundingSource=四川省科技厅项目(2021YFH0165；), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240986262732075614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, xref=1., ext=[AuthorCompanyExt(id=1240986262736269919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, companyId=1240986262732075614, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240986262744658528, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, companyId=1240986262732075614, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/ 华西第四医院，四川 成都 610041)]), AuthorCompany(id=1240986263076008556, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, xref=2., ext=[AuthorCompanyExt(id=1240986263084397165, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, companyId=1240986263076008556, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041)])], figs=[ArticleFig(id=1240986267484222268, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Figure 1, caption=Theoretical model of the mediating effect of obesity on blood pressure from obstructive sleep apnea, figureFileSmall=gFsQLqFxo4ueioRlaN/kHQ==, figureFileBig=k1a2YcsgXcTeHsreKGGo9w==, tableContent=null), ArticleFig(id=1240986267752657734, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=图1, caption=肥胖在OSA对血压的中介效应理论模型, figureFileSmall=gFsQLqFxo4ueioRlaN/kHQ==, figureFileBig=k1a2YcsgXcTeHsreKGGo9w==, tableContent=null), ArticleFig(id=1240986268096590674, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Figure 2, caption=Model diagram of the mediating effect of obesity on obstructive sleep apnea and nocturnal blood pressure, figureFileSmall=bYjEWCkKhU4kiOSDetQ33Q==, figureFileBig=pzzP5Xm7+7F7hdWIdrCBdA==, tableContent=null), ArticleFig(id=1240986268637655895, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=图2, caption=肥胖在OSA对夜间血压的中介作用模型图, figureFileSmall=bYjEWCkKhU4kiOSDetQ33Q==, figureFileBig=pzzP5Xm7+7F7hdWIdrCBdA==, tableContent=null), ArticleFig(id=1240986268780262241, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Figure 3, caption=Effect of AHI on nocturnal blood pressure in obese and non-obese OSA patients, figureFileSmall=VdYypRZLx59sIjbyc39+uw==, figureFileBig=J0V7a94BMruzHOUlOljojA==, tableContent=null), ArticleFig(id=1240986269350687594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=图3, caption=肥胖与非肥胖OSA患者的AHI对夜间血压的效应图, figureFileSmall=VdYypRZLx59sIjbyc39+uw==, figureFileBig=J0V7a94BMruzHOUlOljojA==, tableContent=null), ArticleFig(id=1240986269476516721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Table 1, caption=

Basic characteristics of 753 patients with OSA

, figureFileSmall=null, figureFileBig=null, tableContent=
特征例数（%）/（）
性别
男625（83）
女128（17）
年龄（岁）43.7±12.1
BMI（kg/m2）26.59±8.43
<24202（26.8）
24～27.9335（44.5）
≥28216（28.7）
是否肥胖
是216（28.7）
否537（71.3）
AHI（次/h）38.03±26.64
轻度204（27.1）
中度155（20.6）
重度394（52.3）
血压（mm Hg）
SBP117.82±18.74
DBP78.75±12.37
), ArticleFig(id=1240986269564597116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=表1, caption=

753例OSA患者的一般情况描述

, figureFileSmall=null, figureFileBig=null, tableContent=
特征例数（%）/（）
性别
男625（83）
女128（17）
年龄（岁）43.7±12.1
BMI（kg/m2）26.59±8.43
<24202（26.8）
24～27.9335（44.5）
≥28216（28.7）
是否肥胖
是216（28.7）
否537（71.3）
AHI（次/h）38.03±26.64
轻度204（27.1）
中度155（20.6）
重度394（52.3）
血压（mm Hg）
SBP117.82±18.74
DBP78.75±12.37
), ArticleFig(id=1240986269690426243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Table 2, caption=

Correlations of AHI and BMI with SBP and DBP

, figureFileSmall=null, figureFileBig=null, tableContent=
变量AHIBMI SBP DBP 年龄性别
AHI1.000
BMI0.443***1.000
SBP0.297***0.313***1.000
DBP0.222***0.260***0.755***1.000
年龄0.0250.0060.0640.081**1.000
性别0.262***0.232***0.122***0.126***-0.207***1.000
), ArticleFig(id=1240986269942084488, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=表2, caption=

AHI、BMI与患者SBP、DBP的相关分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量AHIBMI SBP DBP 年龄性别
AHI1.000
BMI0.443***1.000
SBP0.297***0.313***1.000
DBP0.222***0.260***0.755***1.000
年龄0.0250.0060.0640.081**1.000
性别0.262***0.232***0.122***0.126***-0.207***1.000
), ArticleFig(id=1240986270139216783, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=EN, label=Table 3, caption=

Analysis of the mediating effect of obesity in the relationship of obstructive sleep apnea with SBP and DBP

, figureFileSmall=null, figureFileBig=null, tableContent=
模型类型效应类型β（95%CI）值效应占比（%）R2-MR2-BP
M-SBP0.1350.102
直接效应0.228（0.157～0.299）78.62
间接效应0.063（0.035～0.090）21.72
总效应0.290（0.225～0.356 ）100.00
M-DBP0.1100.079
直接效应0.166（0.092～0.239）73.78
间接效应0.059（0.032～0.087）26.22
总效应0.225（0.156～0.293）100.00
), ArticleFig(id=1240986270327960471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972417099690357, language=CN, label=表3, caption=

肥胖在OSA对SBP、DBP的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型类型效应类型β（95%CI）值效应占比（%）R2-MR2-BP
M-SBP0.1350.102
直接效应0.228（0.157～0.299）78.62
间接效应0.063（0.035～0.090）21.72
总效应0.290（0.225～0.356 ）100.00
M-DBP0.1100.079
直接效应0.166（0.092～0.239）73.78
间接效应0.059（0.032～0.087）26.22
总效应0.225（0.156～0.293）100.00
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阻塞性睡眠呼吸暂停和肥胖对夜间血压的影响效应
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李婉姝 1, 2 , 张晓晴 1, 2 , 胡雨阳 1, 2
现代预防医学 | 临床与预防 2024,51(9): 1724-1728
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现代预防医学 | 临床与预防 2024, 51(9): 1724-1728
阻塞性睡眠呼吸暂停和肥胖对夜间血压的影响效应
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李婉姝1, 2, 张晓晴1, 2 , 胡雨阳1, 2
作者信息
  • 1.四川大学华西公共卫生学院/ 华西第四医院，四川 成都 610041
  • 2.四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041

    • 李婉姝（1998—），女，硕士在读，研究方向：劳动卫生与环境卫生

通讯作者:

张晓晴，E-mail:
Effects of obstructive sleep apnea and obesity on nocturnal blood pressure
Wan-shu LI1, 2, Xiao-qing ZHANG1, 2 , Yu-yang HU1, 2
Affiliations
  • West China School of Public Health, Sichuan University / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202402190
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摘要
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目的

分析阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）与夜间血压的关系，并对肥胖在这种联系中的可能效应进行评价，为进一步探索OSA相关高血压的发生机制研究提供基础。

方法

随机选取2021年8月—2022年12月于四川大学华西第四医院睡眠医学中心，因“打鼾、呼吸暂停”等原因就诊，且均完成多导睡眠监测（polysomnography，PSG）后，诊断为OSA的753例成人患者作为研究对象。收集患者一般资料、PSG相关数据、夜间血压相关指标等。采用相关分析、结构方程模型，分析OSA和肥胖对夜间血压的影响作用。

结果

OSA患者AHI和平均收缩压（SBP）、平均舒张压（DBP）均呈正相关（r=0.297、0.222，P<0.001），与BMI呈正相关（r=0.443，P<0.001)；BMI和SBP、DBP呈正相关（r=0.313、0.260，P<0.001）。结构方程模型结果提示，肥胖在OSA对夜间SBP、DBP的影响中存在中介作用。标准化中介效应值分别为0.063（95%CI：0.035～0.090）、0.059（95%CI：0.032～0.087）；中介效应占比分别为21.72%、26.22%。

结论

OSA可直接影响患者血压，与此同时肥胖在OSA对SBP、DBP的影响中存在中介作用。

阻塞性睡眠呼吸暂停  /  肥胖  /  夜间血压  /  中介效应
Objective

To analyze the relationship between obstructive sleep apnea (OSA) and nocturnal blood pressure, and to evaluate the possible effect of obesity in this association, so as to provide reference for further exploring the mechanism of OSA-related hypertension.

Methods

A total of 753 adult patients diagnosed with OSA were randomly selected from August 2021 to December 2022 in the Sleep Medicine Center of the Fourth West China Hospital of Sichuan University because of snoring, apnea, and other reasons. After polysomnography (PSG) was completed, 753 adult patients diagnosed with OSA were selected as research subjects. The general data of patients, PSG related data, nocturnal blood pressure and related indicators were collected. Correlation analysis and structural equation model were used to analyze the effects of OSA and obesity on nocturnal blood pressure.

Results

In patients with OSA, Apnea Hyponea Index (AHI) was positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP) (r=0.297 and 0.222, P < 0.001), and BMI (r=0.443, P < 0.001), and BMI was positively correlated with SBP and DBP (r=0.313 and 0.260, P < 0.001). The results of structural equation model suggested that obesity played an intermediary role in the effect of OSA on nocturnal SBP and DBP. The standardized intermediary effect values were 0.063 (95%CI: 0.035-0.090) and 0.059 (95%CI: 0.032-0.087), respectively, and the proportion of intermediary effect was 21.72% and 26.22%, respectively.

Conclusion

OSA can directly affect the blood pressure of patients. At the same time, obesity plays an intermediary role in the effect of OSA on SBP and DBP.

Obstructive sleep apnea  /  Obesity  /  Nocturnal blood pressure  /  Mediating effect
李婉姝, 张晓晴, 胡雨阳. 阻塞性睡眠呼吸暂停和肥胖对夜间血压的影响效应. 现代预防医学, 2024 , 51 (9) : 1724 -1728 . DOI: 10.20043/j.cnki.MPM.202402190
Wan-shu LI, Xiao-qing ZHANG, Yu-yang HU. Effects of obstructive sleep apnea and obesity on nocturnal blood pressure[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1724 -1728 . DOI: 10.20043/j.cnki.MPM.202402190
正文
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阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）是睡眠障碍中常见的病症之一。其主要表现在睡眠过程中，患者上气道塌陷导致呼吸气流减少或停止，从而在睡眠过程中出现缺氧、微觉醒等情况，且这个过程在夜间睡眠中反复发生。据文献估计，全球有近10亿OSA患者，这一疾患不仅影响患者生活质量，还与一系列身心并发症的发生有关，甚至与生产生活、安全事故有密切联系，可以说OSA已成为越来越受关注的全球性公共卫生问题。OSA患者反复的呼吸暂停、间歇性缺氧、微觉醒等异常夜间睡眠呼吸症状，可能对心血管、生理方面等带来较大影响。有研究表明，OSA不仅可能增加高血压等心血管疾病发生率[1-2]，还与肥胖等代谢性疾患有关联。
目前中国OSA患者估计已达到2亿人，OSA人群中观察到的肥胖率远高于一般人[3]。OSA通过呼吸暂停和低通气事件引起的间歇性低氧血症和二氧化碳潴留，直接激活交感神经系统，导致心率加快和血管收缩，进而影响患者血压水平。同时，OSA的异常呼吸事件也导致睡眠质量降低和内皮功能障碍，还可以通过促进胰岛素抵抗和糖代谢异常促进体重增加和肥胖[4-5]。在这一过程中，肥胖作为一个可能中介变量通过自身引起的炎症反应、肾上腺素系统活性增加和胰岛素抵抗等机制，直接和间接影响夜间血压[6]。因此，肥胖在OSA和夜间血压之间的作用路径中可能扮演了桥梁的角色，既反映了OSA对血压的影响，也通过其自身的生理和代谢异常加剧了血压的升高。这一探索揭示了在针对OSA患者的管理策略中，重视肥胖的控制对于降低血压具有重要意义，进而减少心脑血管疾病的风险。肥胖与高血压的关系及OSA与高血压的研究目前已经有大量的研究证据，而本研究关心的问题是，OSA症状对血压值的影响程度有多大，表征肥胖状态的体质指数(BMI)在OSA对血压变化的影响中是否发挥中介作用。
本研究选用夜间血压指标，探讨上述两个问题。夜间血压通常指在夜间睡眠时的血压水平，如果OSA患者夜间血压上升，这可能是高血压发生的早期迹象。阐明这两个问题将有助于加深对OSA对高血压影响途径的认识，同时可以为该病患人群中开展健康管理和临床干预提供科学证据和理论支持。
1　对象与方法
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1.1　对象
本研究选取2021年8月—2022年12月于四川大学华西第四医院睡眠医学中心因“夜间睡眠打鼾、呼吸暂停”等症状就诊，完善多导睡眠监测（polysomnography，PSG）后，诊断为OSA的成人患者753例，作为本次研究对象。纳入标准：（1）患者有完整的一般资料及睡眠监测数据；（2）经PSG监测诊断为OSA患者；（3）年龄≥18岁。排除标准：（1）除阻塞型低通气呼吸暂停综合征外，患有其他影响睡眠呼吸的疾病者；（2）正在进行呼吸机治疗或者已行鼾症手术的患者；（3）正在服用血压药物、精神药物等患者。
研究获得四川大学华西第四医院医学伦理委员会批准（批件号：HXSY-EC-2021022），所有调查对象均签署知情同意书。
1.2　方法
收集纳入OSA患者的一般资料、睡眠监测数据、血压值等临床数据。
1.2.1　PSG监测
使用SOMNOscreenTM plus PSG±多导睡眠监测仪对患者行整夜睡眠监测，监测时间≥7 h。提醒患者当天禁止饮用咖啡、浓茶等含有咖啡因的饮品以及安眠药物，避免影响患者夜间睡眠质量，减少数据偏倚。技术人员经过统一培训，操作过程中，技术人员严格按照最新版《睡眠及其相关事件判读手册》指导执行[7]，并整夜值守，确保顺利完成监测，获得完整、可靠数据。此研究主要获取呼吸暂停低通气指数（apnea-hypopnea index，AHI）数据，AHI能客观反应OSA患者的病情[8]。根据新《成人阻塞性睡眠呼吸暂停多学科诊疗指南》[8]标准，将纳入的753例患者分为：OSA轻度组（5次/h≤AHI≤15次/h），OSA中度组（15次/h<AHI≤30次/h），OSA重度组（AHI>30次/h）。各项数据均由统一报告分析师判定，控制偏倚。
1.2.2　夜间血压测量
由SOMNOscreenTM仪器的配套组件测得，通过电极片和传感器记录心电图和脉搏波，使用专业软件计算脉搏传导时间及速度，再转换为夜间血压值。经《2020中国动态血压监测指南》[9]指出，此测量方法能较真实反应患者夜间血压情况。本研究主要收集夜间平均收缩压（systolic blood pressure, SBP）、平均舒张压（diastolic blood pressure, DBP）。选用SBP、DBP数据，对研究OSA患者的血压水平具有一定代表性。
1.2.3　体质指数（BMI）分级
正常：BMI为18.5～23.9 kg/m2，超重：BMI为24～27.9 kg/m2，肥胖：BMI为≥28 kg/m2。
1.3　统计学方法
使用Excel 2019录入、整理数据，采用Stata.16统计学软件进行统计描述和推断。采用频数和构成比描述研究对象一般资料分布情况；经正态性检验，研究对象的AHI、BMI、SBP、DBP近似正态分布，采用Pearson检验进行相关分析。根据各变量间的关系，以及现有的文献理论支撑，构建理论模型假设，并运用AMOS 21.0软件进行模型构建与检验假设，见图1。软件计算偏差校正百分位估计效应值95%CI，若置信区间不包括0，说明效应显著。本文检验水准α=0.05。
2　结果
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2.1　研究对象的一般情况
如表1所示，在753例研究对象中，男性患者625例（83%），女性患者128例（17%）；年龄（43.7± 12.1）岁；BMI（26.59±8.43）kg/m2,肥胖患者216例（28.7%），非肥胖患者537例（71.3%）；AHI（38.03±26.64）次/h,轻度OSA患者204例（27.1%），中度OSA患者155例（20.6%），重度OSA患者394例（52.3%）；收缩压（117.82±18.74）mm Hg，舒张压（78.75±12.37）mm Hg。
2.2　AHI、BMI与患者SBP、DBP的相关分析
如表2，患者AHI与SBP、DBP间均呈正相关（r=0.297、0.222，P<0.001）；BMI和SBP、DBP、AHI呈正相关（r=0.313、0.260、0.443，P<0.001）；DBP和年龄呈正相关（r=-0.081，P<0.05）；性别与AHI、BMI、SBP、DBP、年龄均有相关性（P<0.001）。
2.3　肥胖在OSA对夜间血压的中介效应分析
如图2，绘出肥胖在OSA对SBP、DBP的中介效应模型图。加入协变量性别、年龄调整，肥胖在OSA对SBP、DBP间的影响起中介作用。OSA对SBP的总效应为0.290（95%CI：0.225～0.356），直接效应为0.228（95%CI：0.157～0.299），中介效应为0.063（95%CI：0.035～0.090），BMI中介效应占比为21.72%；OSA对DBP的总效应为0.225（95%CI：0.156～0.293），直接效应为0.166（95%CI：0.092～0.239），中介效应为0.059（95%CI：0.032～0.087），BMI中介效应占比为26.22%；SBP、DBP的R2-M值分别为0.135、0.110，R2-BP分别为0.102、0.079。见表3。
3　讨论
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本研究以2021年8月—2022年12月于四川大学华西第四医院睡眠医学中心，诊断为OSA的753例患者作为研究对象，探究了OSA和肥胖对夜间血压的影响作用。753例研究对象中，男性、18～60岁、超重肥胖患者占大多数比例。研究结果显示，结构方程模型假设基本成立，OSA可直接影响患者的夜间血压水平，也可通过肥胖对夜间血压产生间接效应。相关分析显示，AHI与SBP、DBP呈正相关，与Picard等[10]学者对OSA相关指标和血压水平的关系的结论一致。AHI与BMI、SBP、DBP呈正相关，提示OSA患者病情越重，体质指数越高；同时，BMI与SBP、DBP呈正相关，提示BMI越高，血压处于较高水平，结论与Salman等[11]与Makarem等[12]研究结果一致。可能是因为OSA导致间歇性缺氧、交感神经过度驱动及过度氧化应激，并最终导致心血管、脑血管疾病和代谢紊乱[13]。因此，若及时对OSA症状进行干预缓解，可将患者血压水平调整到更适宜的范围。
本研究重点验证了肥胖在OSA对夜间血压的中介效应。构建结构方程模型假设，中介效应分析显示，AHI对SBP、DBP存在直接效应，也存在间接效应。提示着OSA可直接影响夜间血压水平的同时，也通过高体质指数间接影响血压。并且，结果表明肥胖在OSA对SBP、DBP的影响中发挥了重要的中介作用。肥胖在OSA对SBP的中介效应数值为0.063，效应占比21.72%；对SBP的中介效应数值为0.059，效应占比26.22%。绘出的效应预测图显示，随着AHI的增加，SBP、DBP水平也增加；同样的AHI值，肥胖可能与更高的血压水平关联，见图3。这表明肥胖是AHI对血压影响的一个重要影响机制。此结果与Salari等人[14]的研究一致，该研究指出OSA与心血管疾病之间的关联可能部分通过OSA引起的肥胖来影响。与此同时，肥胖通过多种生物机制，如激活交感神经系统、促进炎症反应和内皮功能损害，加剧心血管负担，引发血压上升等。此外，本研究结论也与陈白欣等[15]的研究相似，该研究表明肥胖在OSA病理生理中的重要作用，以及通过减重治疗可以显著改善OSA和相关的血压问题，这强调了在治疗OSA时，体重管理对于减少心血管风险的潜在价值。然而，尽管本研究发现了肥胖在OSA对血压影响的中介效应具有统计学意义，但也要注意到中介变量并未解释所有的效应。提示保持正常BMI水平是OSA患者改善血压水平的有效途径。OSA患者可通过降低体质指数，间接影响血压，进而控制血压水平，预防心脑血管疾病等并发症发生。或者，对于OSA伴高血压、肥胖患者而言，控制体重是一个良好的干预措施。
据研究统计，OSA伴高血压、肥胖患者占相当大的比例[16]，其治疗方式主要有持续正压通气治疗和鼾症微创手术治疗。有研究表明，体重管理和持续正压通气治疗联合进行，可有效缓解OSA病情及控制血压水平。其中，对于中重度患者而言，该方法的效果更为明显[17]。因此，对于OSA患者而言，尤其对于OSA伴高血压、肥胖患者，建议在日常生活中注重体重管理，如制定健康的饮食计划、加强锻炼、定期健康体检等，对控制血压、预防高血压等心脑血管疾病有一定帮助。
本研究资料均来自真实临床数据，资料完整可靠。但仍存在一些局限性：一是研究对象均选自四川大学华西第四医院睡眠医学中心，样本量有限；二是研究对象的一般资料信息有限，如缺乏吸烟、饮酒、腹围等信息，可能产生偏倚，影响研究结果。在今后的研究中，建议从多家不同等级医院随机选择更具代表性的大样本OSA患者，并丰富患者一般资料，探索其他可能的中介变量。
综上所述，OSA不仅会直接影响OSA患者夜间血压，还可能会通过肥胖间接影响患者的夜间血压水平，在OSA对夜间血压的影响路径中发挥着重要的中介作用。因此，单纯OSA患者以及OSA伴高血压、肥胖患者欲预防控制血压水平，建议可重点控制体重；也建议OSA患者减重治疗联合持续正压通气治疗，可能会有更好的疗效，为临床工作提供理论依据。除此之外，也对OSA患者控制血压、预防心脑血管疾病提供自我管理建议，具有一定公共卫生意义。
基金
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  • 四川省科技厅项目(2021YFH0165；)
文献
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参考文献 引证文献
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202402190
  • 接收时间：2024-02-12
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2024-02-12
基金
四川省科技厅项目(2021YFH0165；)
作者信息
    1.四川大学华西公共卫生学院/ 华西第四医院，四川 成都 610041
    2.四川大学华西公共卫生学院/华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心，四川 成都 610041

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