A Study On Obstructive Sleep Apnea-hypopnea Syndrome With Cardiovascular Diseases And Plasma Homocysteine

ObjectiveThe purpose of this study was to investigate the roles of plasma homocysteine (HCY) in physiopathologic process of obstructive sleep apnea-hypopnea syndrome (OSAHS) with cardiovascular diseases (CVD).MethodsFollowing overnight polysomnographic examination,94 habitual snorers were divided into 3 groups:15 simple snorers,42 simple OSAHS and 37 OSAHS with CVD. In Experiment 1, plasma concentrations of HCY and hs-CRP were measured by immunoturdimetric assay. Levels of Lipid and glucose were measured by Olympus 2700 automatic biochemistry analyzer. Compare difference and correlations of the variables including HCY,hs-CRP,Lipid and glucose among 3 groups. In Experiment2, 30 OSAHS patients and 24 OSAHS with CVD patients accepted nasal continuous positive airway pressure (nCPAP) therapy, the latter continued taking cardiovascular drugs. After 3 month nCPAP therapy, HCY and hs-CRP were measured again.ResultsHCY concentrations gradually increase among simply snorers,OSAHS group and OSAHS+CVD group, and the differences were significant[ separately were(9.42±0.68)umol /L,(12.70±2.45) umol /L,(14.63±2.98)umol/L,F=15.042,P=0.000]. The concentrations of hs-CRP among 3 groups also was different(F=6.855,P=0.002),after tested by S-N-K method, there was significant difference between OSAHS group and OSAHS+CVD group [(1.32±0.61)umol /L VS(2.13±1.87)umol /L, P<0.05]. The concentrations of TC,TG and VLDL also were different in 3 groups, but no entirely significant difference about lipid after S-N-K test. HCY exhibited positively correlations with AHI(r= 0.899,P<0.01),RIT(r= 0.835,P<0.01),ODI4(r= 0.760,P<0.01),TS90%(r= 0.721,P<0.01),the longest apnea time(r=0.532,P<0.01),hs-CRP(r=0.542,P<0.01)and negatively correlations with Minspo2(r= -0.749,P<0.01),Meanspo2(r=-0.673,P<0.01), but no closely correlation with lipid. Stepwise multiple regression analysis showed that AHI and RIT were independently associated with serum homocysteine levels, regression equation was: HCY=8.117+0.085*AHI+0.047*RIT(F=116.231 , P=0.000).After 3 months'nCPAP therapy, HCY concentrations in OSAHS and OSAHS+CVD groups decrease significantly, but it was still higher in OSAHS+CVD group than OSAHS group.Conclusion1. Patients with OSAHS had higher plasma HCY levels than simply snorers.2. Patients with combination of OSAHS and cardiovascular diseases had significant elevated HCY levels in comparison with simply OSAHS subjects, the same to hs-CRP. We hypothesize there were inflammation and hyperhomocysteine may contribute to physiopathologic process of cardiovascular diseases in OSAHS patients by inflammatory response.3. Effective nCPAP therapy can decrease HCY concentrations both in OSAHS and OSAHS+CVD groups, so nCPAP can prevention and relieve cardiovascular damage in OSAHS.