【摘要】 目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对24 h血压的影响及相关机制。方法纳入符合入选标准的疑似OSAHS患者84例,进行多导睡眠图(PSG)和24 h动态血压监测,根据呼吸暂停低通气指数(AH I)将所有对象分为四组:非OSAHS组(9例)、轻度OSAHS组(19例)、中度OSAHS组(23例)、重度OSAHS组(33例)。比较各组的昼夜血压值,了解血压变化与PSG各项指标的关系。结果各组血压比较,除轻、中度OSAHS患者无显著差异外,其余各组间无论收缩压(SBP)或舒张压(DBP)差异均有显著性(P均<0.05),重度OSAHS患者较非OSAHS患者SBP高约15 mm Hg,DBP高约10 mm Hg。各组的SBP非杓形比率比较,除轻、中度OSAHS患者无显著差异外,其余各组间差异均有显著性(P均<0.05)(SBP非杓形比率依次为32.6%、54.5%、57.1%、78.3%)。重度OSAHS患者的DBP非杓形比率(54.3%)与其他三组相比差异有显著性(P<0.05)。轻度OSAHS患者的血压与体重指数(BM I)(rSBP昼=0.26,rDBP昼=0.22)、微觉醒指数(M iI)(rSBP昼=0.25,rDBP昼=0.17)、心率变异性(HRV)(rSBP夜=0.18,rDBP夜=0.17)相关。中度OSAHS患者的血压与AH I(rSBP昼=0.31,rDBP昼=0.22,rSBP夜=0.26)、最长低通气时间(LH)(rDBP夜=0.2)相关。重度OSAHS患者的血压与呼吸暂停指数(AI)(rSBP昼=0.61,rDBP昼=0.5,rSBP夜=0.57,rDBP夜=0.48)相关。结论 OSAHS对SBP影响更大;OSAHS患者早期表现为DBP升高及SBP非杓形节律。影响血压的因素因OSAHS的严重程度不同而各异。更多还原

【Abstract】 Objective To study the effects of obstructive sleep apnea hypopnea syndrome(OSAHS) on blood pressure variations,and explore the possible mechanism.Methods 84 adult patients(mean age 50.1±14.8 years,male/female 67/17) were recruited for polysomnography(PSG) and ambulatory blood pressure monitoring.Four groups were identified based on apnea hyponea index(AHI),ie.non-OSAHS group(n=9),mild group(n=19),moderate group(n=23),and severe group(n=33).The blood pressure levels were compared among the four groups.Correlations between PSG indexes,variations of systolic blood pressure(SBP) and diastolic blood pressure(DBP) were analyzed.Results Intergroup blood pressure comparison showed significant differences in SBP and DBP(P<0.05),except for the mild and the moderate OSAHS patients.As compared with the non-OSAHS patients,SBP for those with severe OSAHS was about 15 mm Hg higher,and DBP 10 mm Hg higher.Observation on SBP non-dipping rate indicated that,except for the mild and the moderate OSAHS patients where no significant differences were found,SBP non-dipping rate increased with the severity of OSAHS(the rates were 78.3%,57.1%,54.5%,and 32.6%,respectively for the four groups),whereas DBP non-dipping rate significantly increased in the severe OSAHS patients(54.3%)(P<0.05).For the mild OSAHS patients,blood pressure was foundto be correlated positively with the body mass index(correlation coefficient for day time SBP was 0.26,and for DBP was 0.22),the arousal index(correlation coefficient for day time SBP was 0.25,and for DBP was 0.17),and heart rate variation(correlation coefficient for night time SBP was 0.18,and for DBP was 0.17).For the moderate OSAHS patients,a positive correlation was also found between blood pressure and AHI(correlation coefficient for day time SBP was 0.31,and for DBP was 0.22,correlation coefficient for night time SBP was 0.26),and between blood pressure and the longest hypopnea time during sleep(LH) (correlation coefficient for night time DBP was 0.2).For the severe OSAHS patients,blood pressure was correlated positively with apnea index(AI)(correlation coefficient for day time SBP was 0.61,and for DBP was 0.5,correlation coefficient for night time SBP was 0.57 and for night time DBP was 0.48).Conclusions OSAHS has stronger impact on SBP than on DBP.DBP hypertension and SBP non-dipping are usually found in early OSAHS-affected patients.Factors affecting blood pressure differ with the severity of the OSAHS.更多还原