豆倩云,朱晓昊,张涛,毛治尉,闫振富,陈波,钱晨旭,刘存存,邢瑞星,王平

• 1:郑州大学附属郑州中心医院心血管内科
• 2:漯河市第六人民医院心血管内科

摘要(Abstract)：

目的:探讨中重度阻塞性睡眠呼吸暂停(OSA)对卵圆孔未闭(PFO)封堵术后残余分流的影响，筛选其独立危险因素。方法:回顾性分析2019年1月—2024年12月于郑州大学附属郑州中心医院行PFO封堵术且术前完成睡眠呼吸监测的420例患者资料，按呼吸暂停低通气指数(AHI)分为无OSA组(AHI<5次/h)、中度OSA组(5≤AHI<30次/h)、重度OSA组(AHI≥30次/h)。比较3组临床及相关指标，术后随访1年评估残余分流情况，经单因素分析后采用加权logistic回归联合Firth偏倚校正回归筛选独立危险因素。结果:患者平均年龄(51.20±8.56)岁，男性54.8%,3组基线资料无统计学差异。重度OSA组夜间平均血氧饱和度显著降低，左心房内径、同型半胱氨酸水平及房间隔膜部瘤发生率均显著升高(P<0.05)。术后1年大量残余分流发生率10.2%,中、重度OSA组残余分流发生率显著高于无OSA组(P<0.05)。多因素分析显示，中、重度OSA、PFO长度、同型半胱氨酸水平、左心房内径均为PFO封堵术后残余分流的独立危险因素(均P<0.05)。结论:中重度OSA是PFO封堵术后残余分流的重要独立危险因素，PFO长度增加、同型半胱氨酸升高及左心房内径增大亦会增加该风险，临床需加强此类患者的术前筛查与术后干预。

关键词(KeyWords)： 阻塞性睡眠呼吸暂停;卵圆孔未闭;残余分流

Abstract:

Keywords:

基金项目(Foundation): 2024年河南省医学科技攻关计划项目（No:LHGJ20240925）

作者(Author): 豆倩云,朱晓昊,张涛,毛治尉,闫振富,陈波,钱晨旭,刘存存,邢瑞星,王平

DOI: 10.13201/j.issn.1001-1439.2026.10.007

参考文献(References)：

• [1] Hunt TE,Traaen GM,Aaker??y L,et al.Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation[J].Eur J Intern Med,2025,139:106363.
• [2] Tasali E,Pamidi S,Covassin N,et al.Obstructive sleep apnea and cardiometabolic disease:obesity,hypertension,and diabetes[J].Circ Res,2025,137(5):764-787.
• [3] 张玉顺，蒋世良，朱鲜阳.卵圆孔未闭相关卒中预防中国专家指南[J].心脏杂志，2021,33(1):1-10.
• [4] Kent DM,Wang AY.Patent foramen ovale and stroke:a review[J].JAMA,2025,334(16):1463.
• [5] Schwarz A,Lee A,Gadallah NE,et al.Obstructive sleep apnea(OSA)and patent foramen ovale(PFO),the “perfect storm” for a cryptogenic stroke?case series of four patients[J].Front Stroke,2022,1:916154.
• [6] Lv YD,Ruan LT,Guo AH,et al.Patent foramen ovale(PFO)exacerbates intermittent hypoxia in moderate-to-severe obstructive sleep apnea(OSA)patients[J].Sleep Breath,2025,29(2):186.
• [7] 中华医学会呼吸分会睡眠呼吸障碍学组，中国医学装备协会呼吸病学装备技术专业委员会睡眠呼吸设备学组.成人阻塞性睡眠呼吸暂停高危人群筛查与管理专家共识[J].中华健康管理学杂志，2022,16(8):520-528.
• [8] Yeghiazarians Y,Jneid H,Tietjens JR,et al.Obstructive sleep apnea and cardiovascular disease:a scientific statement from the American heart association[J].Circulation,2021,144(3):e56-e67.
• [9] Rimoldi SF,Ott SR,Rexhaj E,et al.Effect of patent foramen ovale closure on obstructive sleep apnea[J].J Am Coll Cardiol,2015,65(20):2257-2258.
• [10] Witte LS,el Bouziani A,Beijk MAM,et al.Persistence of residual shunt at 6 and 12 months after transoesophageal echocardiography-guided percutaneous closure of a patent foramen ovale for cryptogenic stroke[J].Heart,2024,110(19):1172-1179.
• [11] Harm T,Zdanyte M,Goldschmied A,et al.Pre-interventional transesophageal echocardiography as a reliable predictor of residual shunt following patent foramen ovale closure[J].Clin Res Cardiol,2026,115(3):484-494.
• [12] Turc G,Lee JY,Brochet E,et al.Atrial septal aneurysm,shunt size,and recurrent stroke risk in patients with patent foramen ovale[J].J Am Coll Cardiol,2020,75(18):2312-2320.
• [13] 李炜杰，蒋威，温健恒，等.卵圆孔解剖特征对经皮卵圆孔未闭介入封堵术的影响[J].临床心血管病杂志，2024,40(5):421-425.
• [14] Sorensen SG,Smout R,Spruance SL.Transcranial Doppler quantification of residual shunt after percutaneous patent foramen ovale closure:efficacy of the GORE(??) HELEX septal occluder[J].J Interv Cardiol,2011,24(4):366-372.
• [15] Deng WJ,McMullin D,Inglessis-Azuaje I,et al.Effect of patent foramen ovale closure after stroke on circulatory biomarkers[J].Neurology,2021,97(2):e203-e214.
• [16] Schuchlenz HW,Weihs W,Horner S,et al.The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events[J].Am J Med,2000,109(6):456-462.