The Value Of PPG In Risk Assessment Of Cardiovascular Disease In Patients With OSAHS And Analysis Of Its Influencing Factors

Objective:The purpose of this study was to identify the related factors and clinical value of photoplethysmography?PPG?in evaluating the risk of cardiovascular disease in patients with OSAHS.Methods:A total of 190 patients with suspected OSAHS in the Department of Respiratory and critical Medicine,the second affiliated Hospital of Nanchang University from August 2018 to December 2019 were selected.Basic data?name,sex,age,height,weight,BMI,neck circumference,waist circumference,blood pressure,past medical history,personal history,snoring history,etc.?were collected from patients suspected of OSAHS.All the patients in the group completed more than 7 hours of night sleep monitoring in the sleep monitoring room of our department,and were monitored by PSG and PPG finger pulse oximeter.The monitoring contents include:AHI?RDI?ODI?LSaO₂?MSaO₂?TS90%?CRI.Patients with moderate,severe or mild OSAHS with obvious symptoms or cardiovascular disease were treated with automatic continuous positive airway pressure?Auto-CPAP?pressure titration,and data such as CRI after CPAP treatment were obtained.Spearman correlation analysis was used to analyze the related influence indexes of CRI,and logistic regression analysis was used to screen out the risk factors of CRI.The critical value of CRI in the diagnosis of cardiovascular disease risk in Chinese OSAHS patients was determined by ROC curve,and the diagnostic value was evaluated by sensitivity,specificity and accuracy.Results:A total of 190 patients with suspected OSAHS were enrolled in this study,including 176 males and 14 females,aged between 18 and 90 years old.There were45 patients in snoring group?AHI<5 times/h?,50 patients in mild OSAHS group?AHI 5¹5 times/h?and 95 patients in moderate and severe OSAHS group?AHI>15times/h?.Basic data comparison:there were significant differences in SBP,DBP,weight,BMI,neck circumference and waist circumference among each group,but there was no significant difference in age and height.Comparison of the results of PSG+PPG finger pulse oximeter:there were significant differences in RDI,ODI,LSaO₂,MSaO₂,TS90%and CRI among group?P<0.05?.Correlation analysis showed that CRI was correlated with RDI,ODI,TS90%,AHI,LSaO₂,MSaO₂,smoking history and cardiovascular disease history?P<0.05?,but not with drinking history?P>0.05?.That is,CRI increased with the increase of RDI,ODI,TS90%and AHI,and decreased with the increase of MSaO₂ and LSaO₂.The CRI of patients with smoking history and/or cardiovascular history was higher than that of patients without smoking history and/or cardiovascular history.Subgroup analysis showed that there was a significant difference in CRI before and after CPAP treatment?P<0.05?,that is,CRI decreased significantly after CPAP treatment;binary Logistic regression analysis showed that the risk factors of CRI were:LSaO₂?OR 1.064,95%CI 1.003-1.129,P<0.05?;AHI?OR 0.222,95%CI 0.066-0.741,P<0.05?;Cardiovascular history?OR0.245,95%CI 0.118-0.508,P<0.05?;The ROC curve of CRI to evaluate the risk of cardiovascular disease in Chinese patients with OSAHS:the area under the curve?AUC?is 0.740?P<0.05?.The maximum Youden index is 0.402,and the corresponding critical value is 0.415,that is,0.415?CRI?1 can be evaluated as a high risk group of cardiovascular disease,while 0?CRI<0.415 is a low risk group of cardiovascular disease,with a sensitivity of 0.805,a specificity of 0.597 and a diagnostic accuracy of0.740.Conclusion:1.The parameter CRI derived from ASI algorithm in PPG has high sensitivity and specificity in predicting the risk of OSAHS-related cardiovascular disease.2.The related factors of CRI are RDI,LSaO₂,ODI,MSaO₂,TS90%,AHI,smoking history and cardiovascular history.3.CPAP treatment can improve CRI.It is speculated that CPAP treatment may improve the risk and prognosis of cardiovascular disease in patients with OSAHS.4.PPG can be used as one of the new valuable and simple evaluation criteria for predicting the risk of cardiovascular disease in patients with OSAHS,and may provide guidance for clinical therapeutic intervention.