基于多导睡眠监测的高血压病患者睡眠特点及与痰湿证关系分析
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摘要
目的:探讨基于多导睡眠监测(PSG)的高血压病患者的睡眠特点,及与痰湿证候的关系。方法:收集行PSG的高血病(EH)患者88例,其中痰湿证72例、非痰湿证16例;非EH非高血压病组(non-EH)67例,指标包括总卧床时间(TIB)、总睡眠时间(TST)、睡眠效率(SE)、入睡潜伏期(SL)、快速眼动期占总睡眠时间比(REM/TST)、非快速眼动期占总睡眠时间比(NREM/TST)、脑电醒觉反应指数(ai)、呼吸暂停指数(AI)、低通气指数(HI)、呼吸暂停低通气指数(AHI)、平均氧饱和度(SM)、最低氧饱和度(SN)。结果:EH组内的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)占比高于非EH组(χ2=18.672,P<0.001)。EH组中重度OSAHS占比高于非EH组(χ2=21.727,P<0.001),两组间EH组的AI、HI、AHI、SE显著升高,而SM、SN、TIB显著降低(P<0.05)。高血压病痰湿证组OSAHS占比高于与非痰湿证组(χ2=9.456,P=0.002),痰湿证组中重度OSAHS占比高于非痰湿证组(χ2=18.652,P<0.001)。痰湿证组的AI、HI、AHI较非痰湿证显著升高,SM、SN显著降低(P<0.05)。Logistic回归分析:调整混杂因素后,OSAHS患EH的相对危险度(OR值)为4.693(95%CI[1.894,11.633],P=0.001)。结论:OSAHS是引起高血压病独立危险因素,临床上表现为痰湿证为主要特征。
Objective: To explore the relationship between sleep characteristics in hypertensive patients and phlegmdamp syndrome based on polysomnography. Methods: Eighty-eight patients with essential hypertension(EH) who have conducted polysomnography were collected in our hospital, among which there were 72 cases of phlegm-damp syndrome, 16 cases of non-phlegm-damp syndrome, while 67 cases of non-hypertensive patients were collected as control group at the same time. The observed indicators included time in bed(TIB), total sleep time(TST), sleep efficiency(SE), sleep latency(SL), rapid eye movement sleep/total sleep time(REM/TST), non-rapid eye movement sleep/total sleep time(NREM/TST), arousal index(ai), apnea index(AI), hypopnea index(HI), apnea hypopnea index(AHI), the SpO2 mean(SM) and SpO2 nadir(SN). Results: The percentage of obstructive sleep apnea hypopnea syndrome(OSAHS) in the EH group was higher than that in the non-EH group(χ2=18.672, P<0.001). The moderate to severe OSAHS in the EH group was higher than that in the nonEH group(χ2=21.727, P<0.001). Among the two groups, AI, HI, AHI and SE increased in EH group, but SM, SN and TIB decreased(P<0.05); OSAHS proportion in PDS group was higher than that in non-PDS group(χ2=9.456, P=0.002), and the proportion of moderate and severe OSAHS in PDS group was higher than that in non-PDS group(χ2=18.652, P<0.001). AI, HI and AHI in group PDS were higher than those in non-PDS, while SM and SN in PDS group decreased(P<0.05). Logisticregression analysis: After adjusting the confounding factors, the relative risk of EH in OSAHS was 4.693(95%CI[1.894, 11.633], P=0.001). Conclusion: OSAHS is an independent risk factor for hypertension, and the clinical manifestation is phlegm-damp syndrome.
Objective: To explore the relationship between sleep characteristics in hypertensive patients and phlegmdamp syndrome based on polysomnography. Methods: Eighty-eight patients with essential hypertension(EH) who have conducted polysomnography were collected in our hospital, among which there were 72 cases of phlegm-damp syndrome, 16 cases of non-phlegm-damp syndrome, while 67 cases of non-hypertensive patients were collected as control group at the same time. The observed indicators included time in bed(TIB), total sleep time(TST), sleep efficiency(SE), sleep latency(SL), rapid eye movement sleep/total sleep time(REM/TST), non-rapid eye movement sleep/total sleep time(NREM/TST), arousal index(ai), apnea index(AI), hypopnea index(HI), apnea hypopnea index(AHI), the SpO2 mean(SM) and SpO2 nadir(SN). Results: The percentage of obstructive sleep apnea hypopnea syndrome(OSAHS) in the EH group was higher than that in the non-EH group(χ2=18.672, P<0.001). The moderate to severe OSAHS in the EH group was higher than that in the nonEH group(χ2=21.727, P<0.001). Among the two groups, AI, HI, AHI and SE increased in EH group, but SM, SN and TIB decreased(P<0.05); OSAHS proportion in PDS group was higher than that in non-PDS group(χ2=9.456, P=0.002), and the proportion of moderate and severe OSAHS in PDS group was higher than that in non-PDS group(χ2=18.652, P<0.001). AI, HI and AHI in group PDS were higher than those in non-PDS, while SM and SN in PDS group decreased(P<0.05). Logisticregression analysis: After adjusting the confounding factors, the relative risk of EH in OSAHS was 4.693(95%CI[1.894, 11.633], P=0.001). Conclusion: OSAHS is an independent risk factor for hypertension, and the clinical manifestation is phlegm-damp syndrome.
引文
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[22]Wang A Y.Sleep-disordered breathing and resistant hypertension.Semin Nephrol,2014,34(5):520-531
[23]Cho I J,Pyun W B,Shin G J.The influence of the left ventricular geometry on the left atrial size and left ventricular filling pressure in hypertensive patients,as assessed by echocardiography.Korean Circ J,2009,39(4):145-150
[24]Kato M,Roberts-Thomson P,Phillips B G,et al.Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea.Circulation,2000,102(21):2607-2610
[25]赵化庭,戴海龙,光雪峰.阻塞性睡眠呼吸暂停低通气综合征与高血压关系的研究进展.中国心血管病研究,2015,13(1):5-7
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[27]曾利,史忠,邓国兰,等.阻塞性睡眠呼吸暂停低通气综合征对原发性高血压患者心率变异和血压节律的影响.中华高血压杂志,2010,18(2):124-128
[28]Belaidi E,Joyeux-Faure M,Ribuot C,et al.Major role for hypoxia inducible factor-1 and the endothelin system in promoting myocardial infarction and hypertension in an animal model of obstructive sleep apnea.J Am Coll Cardiol,2009,53(15):1309-1317
[29]Wu C X,Liu Y,Zhang J C.Chronic intermittent hypoxia and hypertension:A review of systemic inflammation and Chinese medicine.Chin J Integr Med,2013,19(5):394-400
[30]Punjabi N M,Beamer B A.C-reactive protein is associated with sleep disordered breathing independent of adiposity.Sleep,2007,30(1):29-34
[31]Luciani A,Villella V R,Esposito S,et al.Cystic fibrosis:A disorder with defective autophagy.Autophagy,2011,7(1):104-106
[32]汪俊剑.持续气道正压通气对OSAHS合并高血压患者血压节律的影响.山东医药,2011,51(39):93-94
[33]武宇宏,杨宇英,徐国刚,等.持续气道正压通气对轻、中度OSAHS患者高血压治疗作用的临床观察.河北医药,2011,33(3):368-369
[34]Rodriguez C L,Jaimchariyatam N,Budur K.Rapid eye movement sleep behavior disorder:A review of the literature and update on Current Concepts.Chest,2017,152(3):650-662
[35]盛红宇,姚晓光,木拉力别克,等.短期持续正压通气治疗对不同性别OSAHS合并高血压患者降压疗效的比较.中华全科医学,2016,14(1):9-11
[36]苏婷,付义,张爱华.阻塞性睡眠呼吸暂停低通气综合征的中医研究概况.国医论坛,2016,31(4):66-68
[37]朱颖文,欧琼,缪晓路.阻塞性睡眠呼吸暂停低通气综合征与中医体质相关性.实用中医内科杂志,2013,27(11):1-2
[38]张爱华,杨春艳,张俊图.OSAHS的中医研究进展.云南中医中药杂志,2012,33(11):69-72
[39]王蕾,石磊,张希龙,等.高血压合并阻塞性睡眠呼吸暂停低通气综合征中医证候的临床研究.中华中医药学刊,2012,30(8):1894-1896
[40]夏,邵国民,陈继忠.痰湿体质与阻塞性睡眠呼吸暂停低通气综合征发病的相关性研究.中国中医药科技,2007,14(2):68-69
[2]Alosco M L,Brickman A M,Spitznagel M B,et al.Reduced cerebral blood flow and white matter hyperintensities predict poor sleep in heart failure.Behav Brain Funct,2013,9:42
[3]Szymanski F M,Filipiak K J,Karpinski G,et al.Occurrence of poor sleep quality in atrial fibrillation patients according to the EHRAscore.Acta Cardiol,2014,69(3):291-296
[4]Amagai Y,Ishikawa S,Gotoh T,et al.Sleep duration and incidence of cardiovascular events in a Japanese population:The Jichi Medical School cohort study.J Epidemiol,2010,20(2):106-110
[5]Partinen M.Epidemiology of sleep disorders.Handb Clin Neurol,2011,98:275-314
[6]张倩,张丙芳.阻塞性睡眠呼吸暂停低通气综合征与高血压的相关分析.心脏杂志,2015(4):486-489
[7]郑泽辉.阻塞性睡眠呼吸暂停低通气综合症与高血压的相关研究.医学信息,2010,23(2):359-361
[8]梅宝菲,孔一慧,李为民.睡眠障碍与心血管疾病研究新进展.心血管病学进展,2015,36(5):603-605
[9]中国高血压防治指南修订委员会.中国高血压防治指南2010.中华心血管病杂志,2011,39(7):579-616
[10]CFDA.中药新药临床研究指导原则(试行).北京:中国医药科技出版社,2002:240-245
[11]Somers V K,White D P,Amin R,et al.Sleep apnea and cardiovascular disease:An American Heart Association/american College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee,Council on Clinical Cardiology,Stroke Council,and Council On Cardiovascular Nursing.In collaboration with the National Heart,Lung,and Blood Institute National Center on Sleep Disorders Research(National Institutes of Health).Circulation,2008,118(10):1080-1111
[12]苏航,白俊云,夏涵,等.睡眠障碍与中老年高血压相关性研究.中国老年保健医学,2014(1):65-67
[13]黎娇,况九龙.阻塞性睡眠呼吸暂停低通气综合征相关难治性高血压研究进展.中国老年学杂志,2016,36(11):5756-5758
[14]中华医学会呼吸病学分会睡眠呼吸疾病学组.睡眠呼吸暂停人群高血压患病率的多中心研究.中华结核和呼吸杂志,2007,30(12):894-897
[15]He Q Y,Feng J,Zhang X L,et al.Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome.Chin Med J(Engl),2012,125(10):1740-1746
[16]杜丽娜,任蓉,谭璐,等.阻塞性睡眠呼吸暂停综合征患者日间嗜睡与高血压的关系.中华医学杂志,2016,96(42):3370-3374
[17]Kapur V K,Resnick H E,Gottlieb D J.Sleep disordered breathing and hypertension:does self-reported sleepiness modify the associati on?Sleep,2008,31(8):1127-1132
[18]Troncoso Brindeiro C M,da Silva A Q,Allahdadi K J,et al.Reactive oxygen species contribute to sleep apnea-induced hypertension in rats.Am J Physiol Heart Circ Physiol,2007,293(5):2971-2976
[19]Loredo J S,Ancoli-Israel S,Dimsdale J E.Sleep quality and blood pressure dipping in obstructive sleep apnea.Am JHypertens,2001,14(9Pt1):887-892
[20]Pepin J L,Borel A L,Tamisier R,et al.Hypertension and sleep:Overview of a tight relationship.Sleep Med Rev,2014,18(6):509-519
[21]Li J,Chen X,Sun J.Is the grading system of the severity of the OSAHS used presently rational or not?:from the view of incidence of hypertension in different severity groups.Eur Arch Otorhinolaryngol,2014,271(9):2561-2564
[22]Wang A Y.Sleep-disordered breathing and resistant hypertension.Semin Nephrol,2014,34(5):520-531
[23]Cho I J,Pyun W B,Shin G J.The influence of the left ventricular geometry on the left atrial size and left ventricular filling pressure in hypertensive patients,as assessed by echocardiography.Korean Circ J,2009,39(4):145-150
[24]Kato M,Roberts-Thomson P,Phillips B G,et al.Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea.Circulation,2000,102(21):2607-2610
[25]赵化庭,戴海龙,光雪峰.阻塞性睡眠呼吸暂停低通气综合征与高血压关系的研究进展.中国心血管病研究,2015,13(1):5-7
[26]辛亚男,郭阳.OSAHS合并高血压患者的临床特征分析.临床肺科杂志,2014,19(12):2174-2178
[27]曾利,史忠,邓国兰,等.阻塞性睡眠呼吸暂停低通气综合征对原发性高血压患者心率变异和血压节律的影响.中华高血压杂志,2010,18(2):124-128
[28]Belaidi E,Joyeux-Faure M,Ribuot C,et al.Major role for hypoxia inducible factor-1 and the endothelin system in promoting myocardial infarction and hypertension in an animal model of obstructive sleep apnea.J Am Coll Cardiol,2009,53(15):1309-1317
[29]Wu C X,Liu Y,Zhang J C.Chronic intermittent hypoxia and hypertension:A review of systemic inflammation and Chinese medicine.Chin J Integr Med,2013,19(5):394-400
[30]Punjabi N M,Beamer B A.C-reactive protein is associated with sleep disordered breathing independent of adiposity.Sleep,2007,30(1):29-34
[31]Luciani A,Villella V R,Esposito S,et al.Cystic fibrosis:A disorder with defective autophagy.Autophagy,2011,7(1):104-106
[32]汪俊剑.持续气道正压通气对OSAHS合并高血压患者血压节律的影响.山东医药,2011,51(39):93-94
[33]武宇宏,杨宇英,徐国刚,等.持续气道正压通气对轻、中度OSAHS患者高血压治疗作用的临床观察.河北医药,2011,33(3):368-369
[34]Rodriguez C L,Jaimchariyatam N,Budur K.Rapid eye movement sleep behavior disorder:A review of the literature and update on Current Concepts.Chest,2017,152(3):650-662
[35]盛红宇,姚晓光,木拉力别克,等.短期持续正压通气治疗对不同性别OSAHS合并高血压患者降压疗效的比较.中华全科医学,2016,14(1):9-11
[36]苏婷,付义,张爱华.阻塞性睡眠呼吸暂停低通气综合征的中医研究概况.国医论坛,2016,31(4):66-68
[37]朱颖文,欧琼,缪晓路.阻塞性睡眠呼吸暂停低通气综合征与中医体质相关性.实用中医内科杂志,2013,27(11):1-2
[38]张爱华,杨春艳,张俊图.OSAHS的中医研究进展.云南中医中药杂志,2012,33(11):69-72
[39]王蕾,石磊,张希龙,等.高血压合并阻塞性睡眠呼吸暂停低通气综合征中医证候的临床研究.中华中医药学刊,2012,30(8):1894-1896
[40]夏,邵国民,陈继忠.痰湿体质与阻塞性睡眠呼吸暂停低通气综合征发病的相关性研究.中国中医药科技,2007,14(2):68-69