摘要目的:探讨在急性冠脉综合征（ACS）患者中，不同腰臀比与睡眠呼吸障碍的关系及其对患者远期预后的影响。方法:连续纳入2015年6月至2017年5月间就诊于北京安贞医院急诊综合病房诊断为ACS并进行了睡眠呼吸监测的患者725例。根据腰臀比大小和性别分为低腰臀比组、中低腰臀比组、中高腰臀比组和高腰臀比组。分别比较四组患者的睡眠呼吸障碍相关指标的差异，利用多元Logistic回归分析不同腰臀比与睡眠呼吸障碍的相关性。并且利用COX回归分析和Kaplan-Meier曲线比较四组患者预后差异。结果:随腰臀比增加，暂停低通气指数（AHI）升高（ P=0.004），睡眠呼吸暂停低通气综合征（OSAHS）的比例增加（39.3%比46.0%比53.2%比60.0%， P=0.004），低通气次数升高（ P<0.001），并且平均和最低SaO 2均下降（均 P<0.001）。Logistic回归分析显示，高腰臀比是OSAHS的相关因素（ OR=2.579，95 %CI 1.521~4.373， P<0.001）。生存曲线显示四组主要心脑血管事件（MACCE）发生情况，高腰臀比组MACCE发生率最高（Log Rank P=0.036）。COX回归分析示，高腰臀比是ACS患者MACCE的独立危险因素（ HR=2.855，95 %CI 1.375~5.929， P=0.005）。 结论:本研究发现在ACS患者中中心型肥胖越严重，夜间低通气和缺氧越严重。高腰臀比的患者预后较差，腰臀比升高与睡眠呼吸障碍共同影响着患者预后。

abstractsObjective:To investigate the relationship between different waist-hip ratios and sleep-disordered breathing (SDB) in patients with acute coronary syndrome (ACS) and its effect on patients' long-term prognosis.Methods:A total of 725 patients who were diagnosed with ACS in the emergency ward of Beijing An Zhen Hospital from June 2015 to May 2017 were included, and all the patients were monitored for sleep and breathing. Patients were divided into four groups according to their waist-hip ratios. The differences of SDB-related indicators among the four groups were compared, and the correlation between different waist-hip ratios and SDB was analyzed using multiple logistic regression. COX regression analysis and Kaplan-Meier curve were used to compare the prognostic differences among the four groups.Results:As the waist-hip ratio increased, the apnea hypopnea index (AHI) ( P=0.004) and the proportion of sleep apnea hypopnea syndrome (OSAHS) increased (39.3% vs 46.0% vs 53.2% vs 60.0%, P=0.004). Meanwhile, the number of hypoventilation increased, and the mean and minimum arterial oxygen saturation (SaO 2) decreased (all P<0.001). Logistic regression analysis showed that high waist-hip ratio was significantly related with OSAHS ( OR=2.579, 95% CI 1.521-4.373, P<0.001). The survival curves showed the highest incidence of major cardio-cerebral vascular events (MACCE) occurred in the high waist-hip ratio group (Log Rank P=0.036). COX regression analysis showed that high waist-hip ratio was an independent risk factor for MACCE in ACS patients ( HR=2.855, 95% CI 1.375-5.929, P=0.005). Conclusions:In ACS patients, central obesity is related with SDB. Patients with high waist-hip ratio have a poor prognosis. Elevated waist-hip ratio and SDB jointly impact the prognosis of ACS patients.