Blood Homocysteine Levels In Patients With Obstructive Sleep Apnea Hypopnea Syndrome And Its Relationship With Cardiovascular Disease

Backgroundobstructive sleep apnea hypopnea syndrome(OSAHS)is a clinical syndrome in which obstructive sleep apnea and/or hypopnea occur repeatedly under various causes,leading to intermittent hypoxemia,hypercapnia and sleep fragmentation,thus causing a serious of pathological and physiological changes in the body.OSAHS is a cardiovascular risk factor independent obesity,age and other factors.Hyperhomocysteine(Hcy)is also considered as an independent risk factor for atherosclerosis and thromboembolic diseases.OSAHS and hyperhomocysteinemia have similar pathological mechanisms,so it is of great siginificance to observe the blood homocysteine level of OSAHS and explore the possible internal links between OSAHS and cardiovascular diseases.ObjectiveThe purpose of this study is to compare the level of plasma homocysteine(Hcy)in OSAHS patients with or without coronary heart disease(CHD),the differences of serum homocysteine levels in patients with different severity of OSAHS and its correlation with sleep monitoring indexes were observed,to investigate the effect of OSAHS treatment on homocysteine level.and the internal mechanism as well as the relationship between OSAHS and cardiovascular disease were further studied.Methods1.A total of 288 male patients in Nanfang hospital from January 2016 to July 2018 were included,the patients were divided into 4 groups:OSAHS patients with CHD(n=49),OSAHS patients(n=162),CHD patients without or with low likelihood of sleep apnea(n=50),and healthy control subjects(n=27).The differences of Hcy level and general demographic and polysomnographic data were compared.Then the correlation with apnea hypopnea index,nocturnal lowest oxygen saturation and mean oxygen saturation were analyzed between the groups.2.A total of 187 male patients newly diagnosed with snoring in the Nanfang hospital from October 2015 to October 2018 were collected.After polysomnography monitoring,patients were divided into severe OSAHS group(n=93),non-severe OSAHS group(n=67)and simple snoring group(n=27),and the differences in general conditions,blood Hcy level,blood lipid file were analyzed.Multivariate linear regression was used to evaluate the correlation between blood Hcy level and sleep monitoring indexes.At the same time,the changes in serum Hcy levels before and after treatment were compared in 15 patients who received continuous positive airway pressure ventilation for 1 month and were followed up actively.3.The article reviews the effects and progress of intermittent hypoxia and oxidative stress caused by obstructive sleep apnea on cardiovascular disease.Results1.Serum Hcy level in the three case group was significantly higher than the healthy control group(P<0.001),and the CHD combined with OSAHS group was significantly higher than simple CHD group and OSAHS group(15.69±5.15?mol/L,13.18±5.48?mol/L,12.74±3.07?mol/L,respectively,P<0.05).While the CHD group and OSAHS group show no statistically significant differences(P>0.05).Serum Hcy level had negatively correlated with nocturnal lowestSaO2(r=-0.177,P=0.008)and meanSaO2(r=-0.134,P=0.039).2.There was a statistically significant difference in blood Hcy level between severe OSAHS group,non-severe OSAHS group and simple snoring group(P<0.001),and the serum homocysteine level of OSAHS patient was significantly higher than that of non-OSAHS patient.Among the lipid file,the triglyceride and cholesterol levels of severe OSAHS group was significantly higher than that of non-severe OSAHS group,while the high-density lipoprotein levels were lower than the other two groups,with statistical significance(P<0.05).serum Hcy level and Cr(r=0.197,P=0.007),AHI(r=0.326,P<0.01),BMI(r=0.284,P<0.01),abdominal circumference(r=0.291,P<0.01),neck circumference(r=0.277,P<0.01)were positively correlated,and negatively correlated with lowestSa02 and meanSa02(r=-0.357,r=-0.240,respectively).3.In multiple linear regression equation,serum Hcy was taken as the dependent variable,and age,BMI,neck and abdominal circumference,Cr,lipid levels,AHI,lowestSaO2 and meanSaO2 were taken as independent variables.It was found that the Cr and lowestSaO2 was still correlated with Hcy after controlling for other confounding factors.4.The mean blood Hcy level of patient with OSAHS before continuous positive airway pressure ventilation was 11.47±4.27?mol/L,and after 1 month treatment was 11.00±3.23?mol/L,there was no significant change(P>0.05).ConclusionBlood homocysteine levels in patient with obstructive sleep apnea hypopnea syndrome tend to rise,in patients with OSAHS and coronary heart disease were significantly increased,and homocysteine levels related to its severity and hypoxemia.The onset of OSAHS process may affect the blood homocysteine metabolism,and the elevated homocysteine levels in the blood may be an important risk factor for the development of cardiovascular disease in patient with OSAHS.