阻塞性睡眠呼吸暂停低通气综合征与高血压患者夜间收缩压波动程度的相关性研究
|
摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压患者夜间收缩压波动程度的相关性。方法对69例疑诊OSAHS高血压患者行多导睡眠及脉搏波传导时间法无创血压监测,根据睡眠呼吸暂停低通气指数(AHI)分为对照组(AHI<5)、轻度组(5≤AHI≤15)、中度组(1530),比较各组夜间收缩压波动相关参数及多导睡眠监测参数,并行相关性分析。结果 OSAHS轻、中、重度组睡眠期呼吸相关收缩压上升指数、收缩压上升平均值(ASVs)、快动眼睡眠期收缩压标准差(SDs)显著高于对照组(均P<0.05);ASVs及SDs与脉搏血氧饱和度均呈负相关(均P<0.01);与AHI及其它缺氧相关参数均呈正相关(均P<0.01)。多元线性回归分析示氧减指数是影响呼吸相关收缩压上升指数的重要因素(B=0.400,t=3.128,P=0.003)。结论高血压并OSAHS患者夜间收缩压波动程度增加,间歇性低氧血症与收缩压波动程度增加密切相关。
Objective To investigate the association of obstructive sleep apnea hypopnea syndrome(OSAHS) with fluctuation of night systolic blood pressure in patients with hypertension. Methods According to sleep apnea hypopnea index(AHI), 69 cases with hypertension who had been checked on polysomnography(PSG) and continuous noninvasive monitoring of blood pressure based on pulse transit time(PPT) simultaneously were divided into the control group(AHI<5), the mild group(5≤AHI≤15), the moderate group(1530). Blood pressure fluctuation related parameters and PSG were analyzed. Bivariate analysis and multiple linear regression analysis were used to analyze their correlation. Results The rising indexes of respiratory accidents related systolic pressure, the average rising value of systolic pressure(ASVs) during sleep time, and standard deviation of systolic blood pressure(SDs) during REM sleep time in each group with OSAHS were significantly higher than those in the control group respectively(all P<0.05). SDs during REM sleep time in the mild, moderate, and severe group were 7.8(7.0, 10.8) mmHg, 8.3(6.1, 11.8) mmHg, and 10.1(8.5, 20.8) mmHg, which were significantly higher than those during nonREM sleep time respectively [6.4(5.8, 8.0) mmHg, 7.2(5.4, 8.8) mmHg, and 7.9(6.7, 12.3) mmHg](all P<0.05). ASVs and SDs during sleep time were negatively correlated with saturation of pulse oximetry significantly(all P<0.01), and they were positively correlated with AHI and other hypoxia related parameters(all P<0.01). Multiple linear regression analysis showed that oxygen desaturation index was a significant factor affecting respiratory accidents related systolic pressure rising index(B=0.400, t=3.128, P=0.003). Conclusion Hypertensive complicated with OSAHS has higher degree of night systolic blood pressure fluctuation, and intermittent hypoxia is closely related to it.
Objective To investigate the association of obstructive sleep apnea hypopnea syndrome(OSAHS) with fluctuation of night systolic blood pressure in patients with hypertension. Methods According to sleep apnea hypopnea index(AHI), 69 cases with hypertension who had been checked on polysomnography(PSG) and continuous noninvasive monitoring of blood pressure based on pulse transit time(PPT) simultaneously were divided into the control group(AHI<5), the mild group(5≤AHI≤15), the moderate group(15
引文
[1] LAU K K,WONG Y K,CHANG R S K,et al.Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct[J].Eur J Neurol,2013,21(2):319-325.
[2] BILO G,PARATI G.Rate of blood pressure changes assessed by 24h ambulatory blood pressure monitoring:another meaningful index of blood pressure variability?[J].J Hypertens,2011,29(6):1054-1058.
[3] GóMEZ GARCíA M T,TRONCOSO ACEVEDO M F,RODRIGUEZ GUZMáN M,et al.Can pulse transit time be useful for detecting hypertension in patients in a sleep unit?[J].Arch Broncoenumol,2014,50(7):278-284.
[4] 白丽红,王成,文苗,等.基于脉搏波传导时间的连续血压监测系统[J].生物医学工程研究,2014,33(4):221-225.
[5] 黄思代.阻塞性睡眠呼吸暂停低通气综合征与高血压病[J].临床肺科杂志,2006,11(2):220.
[6] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[S].中华结核和呼吸杂志,2012,35(1):9-12.
[7] IBER C,ANCOLI-ISRAEL S,CHESSON JR A L,et al.美国睡眠医学会睡眠及其相关事件判读手册:规则、术语和技术规范[S].高和,江小丽,译.北京:人民军医出版社,2010:16-47.
[8] 中国老年医学学会高血压分会.老年人异常血压波动临床诊疗中国专家共识[S].中国心血管杂志,2017,22(1):1-11.
[9] SAWATARI H,CHISHAKI A,NISHIZAKA M,et al.Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing[J].Am J Hypertens,2016,29(4):458-463.
[10] THUNSTR?M E,GLANTZ H,FU M,et al.Increased inflammatory activity in nonobese patients with coronary artery disease and obstructive sleep apnea[J].Sleep,2015,38(3):463-741.
[2] BILO G,PARATI G.Rate of blood pressure changes assessed by 24h ambulatory blood pressure monitoring:another meaningful index of blood pressure variability?[J].J Hypertens,2011,29(6):1054-1058.
[3] GóMEZ GARCíA M T,TRONCOSO ACEVEDO M F,RODRIGUEZ GUZMáN M,et al.Can pulse transit time be useful for detecting hypertension in patients in a sleep unit?[J].Arch Broncoenumol,2014,50(7):278-284.
[4] 白丽红,王成,文苗,等.基于脉搏波传导时间的连续血压监测系统[J].生物医学工程研究,2014,33(4):221-225.
[5] 黄思代.阻塞性睡眠呼吸暂停低通气综合征与高血压病[J].临床肺科杂志,2006,11(2):220.
[6] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[S].中华结核和呼吸杂志,2012,35(1):9-12.
[7] IBER C,ANCOLI-ISRAEL S,CHESSON JR A L,et al.美国睡眠医学会睡眠及其相关事件判读手册:规则、术语和技术规范[S].高和,江小丽,译.北京:人民军医出版社,2010:16-47.
[8] 中国老年医学学会高血压分会.老年人异常血压波动临床诊疗中国专家共识[S].中国心血管杂志,2017,22(1):1-11.
[9] SAWATARI H,CHISHAKI A,NISHIZAKA M,et al.Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing[J].Am J Hypertens,2016,29(4):458-463.
[10] THUNSTR?M E,GLANTZ H,FU M,et al.Increased inflammatory activity in nonobese patients with coronary artery disease and obstructive sleep apnea[J].Sleep,2015,38(3):463-741.