重度OSA患者眼动脉及视网膜中央动脉血流动力学参数与AHI、LSaO₂的关联性

Correlation between hemodynamic parameters of the ophthalmic artery and central retinal artery in patients with severe OSA with AHI and LSaQ ₂

摘要

目的 评估重度阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)患者眼动脉(ophthalmic artery, OA)及视网膜中央动脉(central retinal artery, CRA)血流动力学参数与呼吸暂停低通气指数(apnea-hypopnea index, AHI)、夜间最低氧饱和度(lowest nocturnal oxygen saturation, LSaO₂)的关联性。方法 纳入重度OSA患者30例,其中男27例、女3例,年龄(43.08±4.86)岁,采用1∶1倾向评分匹配(propensity score matching, PSM)从同期招募的健康对照者中筛选匹配对象,匹配变量为年龄、性别、体质量指数。所有受试者均完成整夜多导睡眠监测(polysomnography, PSG)、Epworth嗜睡量表、眼内压(intraocular pressure,IOP)及彩色多普勒超声(color Doppler ultrasound,CDU)检测。采用CDU测量OA和CRA的收缩期峰值速度(peak systolic velocity, PSV)、舒张末期速度(end-diastolic velocity, EDV)、平均血流速度、搏动指数和阻力指数,单眼测量采用随机数字表法。分析血流动力学参数与AHI、夜间LSaO₂的相关性。结果 重度OSA组的IOP高于对照组(t=2.293,q<0.05)。OSA组CRA PSV、CRA EDV、OA PSV、OA EDV均降低(t值分别为4.670、-4.152、6.908、6.395,q均<0.001)。重度OSA组CRA PSV与AHI、LSaO₂呈负相关(r=-0.478,P=0.008;r=-0.362,P=0.049);OA PSV与AHI、LSaO₂亦呈负相关(r=-0.395,P=0.031;r=-0.481,P=0.007)。多因素线性回归提示,重度OSA患者的AHI和LSaO₂可独立预测CRA PSV降低(b=-0.064,P<0.05;b=-0.067,P<0.05);其LSaO₂是OA PSV降低的独立相关因素(b=-0.170,P<0.05)。结论 重度OSA患者存在IOP升高和OA、CRA血流速度的降低,其血流动力学异常程度与AHI及LSaO₂水平独立相关,提示慢性间歇性低氧暴露可能影响视网膜供血微循环。

Abstract

Objective The objective of this study is to evaluate the correlation between the hemodynamic parameters of the ophthalmic artery (OA) and the central retinal artery (CRA) in patients diagnosed with severe obstructive sleep apnea (OSA), as well as their apnea-hypopnea index (AHI) and lowest nocturnal oxygen saturation (LSaO₂). Methods Thirty patients diagnosed with severe OSA were included in the study, The study population comprised 27 men and 3 women, with an average age of 43.08±4.86 years. A 1:1 propensity score matching (PSM) procedure was employed to select matched controls from healthy participants recruited during the same period, with the selection based on variables such as age, sex and body mass index (BMI). All subjects underwent full-night polysomnography (PSG), Epworth sleepiness Scale (ESS), intraocular pressure (IOP), and color Doppler ultrasound (CDU) tests. The present study utilised the continuous Doppler ultrasound(CDU)to assess various parameters of ocular blood flow, namely the peak systolic velocity( PSV), the end-diastolic velocity( EDV), the mean flow velocity( MFV), the pulsatility index (PI), and the resistance index (RI) of the ophthalmic artery(OA)and the central retinal artery(CRA).The random number table method was employed to ensure the randomisation of measurements across both eyes. The present study sought to analyse the correlations between hemodynamic parameters and AHI and LSaO ₂. Results The IOP of the severe OSA group was found to be statistically higher than that of the control group (t=2.293, q<0.05). In the OSA group, the levels of CRA PSV, CRA EDV, OA PSV and OA EDV were found to be significantly lower (p<0.001; Table 1). The investigation revealed a significant negative correlation between CRA PSV and AHI in the severe OSA group ( r =-0. 478, P =0. 008). Additionally, a similar correlation was observed between CRA PSV and LSaO₂ in the severe OSA group(r=-0.362, P=0.049). Furthermore, the investigation revealed a significant negative correlation between OA PSV and AHI (r=-0.395, P=0.031). In addition, a similar correlation was observed between OA PSV and LSaO₂(r=-0.481, P=0.007). Multivariate linear regression analysis indicated that AHI and LSaO₂ independently predicted reductions in CRA PSV in severe OSA patients (b=-0.064, P<0.05; b=-0.067, P<0.05), and LSaO₂ was an independent factor related to reduced OA PSV (b =-0.170, P<0.05). Conclusion Patients diagnosed with severe OSA have been shown to exhibit increased intraocular pressure (IOP) and decreased blood flow velocities in OA and CRA. The degree of hemodynamic abnormalities has been shown to be independently associated with AHI and LSaO₂ levels, suggesting that intermittent chronic hypoxia may have a detrimental effect on the microcirculation of the retinal blood supply.

关键词

睡眠呼吸暂停,阻塞性 / 眼动脉 / 视网膜中央动脉 / 血流动力学参数 / 超声检查,多普勒,彩色

Key words

Sleep apnea, obstructive / Ophthalmic artery / Central retinal artery / Hemodynamic parameters / Ultrasonography, doppler, color

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基金资助

淮安市基础研究计划指导性项目(HABZ202309)