【摘要】 目的:探讨阻塞性睡眠呼吸暂停(OSA)对血压的复杂调节作用。方法:对2008-05至2009-05在本中心就诊的患者行整夜多导睡眠监测和晨起血压测量,根据呼吸暂停低通气指数(AHI)和最低血氧饱和度筛选共277例患者入选。对照组26例(AHI<5),单纯OSA组115例分为轻度亚组(5≤AHI<20)37例、中度亚组(20≤AHI<40)29例、重Ⅰ度亚组(40≤AHI<60)24例、重Ⅱ度亚组(AHI≥60)25例共4个亚组;OSA合并高血压病组136例,按单纯OSA组AHI标准分为轻度亚组27例、中度亚组20例、重Ⅰ度亚组33例、重Ⅱ度亚组56例共4个亚组。结果:与对照组比较,单纯OSA组和OSA合并高血压病组体重指数、AHI、最长呼吸暂停时间、氧饱和度低于90%的时间百分比、微觉醒指数、舒张压和平均动脉压均增加,最低血氧饱和度、平均血氧饱和度均降低,差异均有统计学意义(P均<0.05)。单纯OSA组中度、重Ⅰ度、重Ⅱ度三亚组舒张压较轻度亚组升高,差异均有统计学意义(P均<0.05)。OSA合并高血压病组中度、重Ⅱ度二亚组较轻度亚组收缩压和舒张压升高,差异均有统计学意义(P均<0.05);OSA合并高血压病组平均动脉压中度亚组较轻度亚组升高,重Ⅰ度、重Ⅱ度二亚组较中度亚组降低,差异均有统计学意义(P均<0.05)。单纯OSA组轻度亚组舒张压与AHI呈正相关(r=0.69,P<0.05);重Ⅱ度亚组平均动脉压与最低血氧饱和度呈负相关(r=-0.60,P<0.05)。OSA合并高血压病组轻度亚组收缩压与最长呼吸暂停时间呈正相关(r=0.60,P<0.05);中度亚组收缩压与最长呼吸暂停时间呈正相关(r=0.73,P<0.05),舒张压、平均动脉压与AHI呈正相关(r分别为0.88和0.86,P<0.05);重Ⅰ度亚组舒张压、平均动脉压与AHI呈负相关(r分别为-0.58和-0.70,P<0.05),舒张压与最低血氧饱和度呈正相关(r=0.47,P<0.05)。结论:OSA对血压的影响情况因病情程度不同而异。更多还原

【Abstract】 Objective:To investigate the effect of obstructive sleep apnea syndrome(OSAS) on human blood pressure. Methods:A total of 277 OSAS patients were divided to three large groups.Control group,n=26,apnea hypopnea index(AHI)<5.OSAS group,n=115 which including 4 subgroups as Mild subgroup,n=37,(5≤AHI<20),Moderate subgroup,n=29,(20≤AHI<40),Severe I subgroup,n=24,(40≤AHI<60),and severe Ⅱ subgroup,n=25,(AHI≥60).OSAS with hypertension group,n=136 which including 4 subgroups as Mild,n=27,Moderate,n=20,Severe I,n=33,and severe Ⅱ,n=56.All patients received sleeping monitor at night and blood pressure check in the morning. Results:Compared with Control group,in OSAS group and OSAS with hypertension group,the patients presented increased BMI,AHI,diastolic blood pressure,mean arterial pressure and decreased minimum oxygen saturation,mean oxygen saturation,P<0.05 respectively.In OSAS group,compared with Mild subgroup,the patients had increased diastolic blood pressure in Moderate,Severe I and Severe Ⅱ subgroups,P<0.05respectively.In OSAS with hypertension group,compared with Mild subgroup,the patients had increased systolic and diastolic blood pressure in Moderate and Severe Ⅱ subgroups,P<0.05 respectively.In OSAS group,the diastolic blood pressure positively related to AHI in Mild subgroup(r=0.69,P<0.05);the mean arterial pressure negatively related to minimum oxygen saturation in Sereve Ⅱ subgroup(r=-0.60,P<0.05).In OSAS with hypertension group,the systolic blood pressure positively correlated with the longest apnea time in Mild subgroup(r=0.60,P<0.05);the systolic blood pressure positively correlated with the longest apnea time(r=0.73,P<0.05) and the diastolic blood pressure,mean arterial pressure positively correlated with AHI(r=0.88 and 0.86,P<0.05 respectively) in Moderate subgroup;the diastolic blood pressure,mean arterial pressure negatively correlated with AHI(r=-0.58 and-0.70,P<0.05 respectively) and the diastolic blood pressure positively correlated with minimum oxygen saturation(r=0.47,P<0.05) in Severe I subgroup. Conclusion:OSAS affects human blood pressure according to the severity of disease.更多还原