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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
徐靖,丁宁,陈亮,黄茂,孟自力.重度阻塞性睡眠呼吸暂停低通气综合征夜间血压波动特点及其继发高血压病的相关因素[J].中华老年多器官疾病杂志,2018,17(9):682~686
重度阻塞性睡眠呼吸暂停低通气综合征夜间血压波动特点及其继发高血压病的相关因素
Characteristics of nocturnal blood pressure variability and relative factors of secondary hypertension in the patients with severe obstructive sleep apnea hypopnea syndrome
投稿时间:2018-04-17  修订日期:2018-06-12
DOI:10.11915/j.issn.1671-5403.2018.09.156
中文关键词:  阻塞性睡眠呼吸暂停;高血压病;血压波动;缺氧;微觉醒
英文关键词:obstructive sleep apnea syndrome; hypertension; blood pressure fluctuation; hypoxia; arousal
基金项目:
作者单位E-mail
徐靖 南京医科大学附属淮安第一医院呼吸科,淮安 223300  
丁宁 南京医科大学附属淮安第一医院呼吸科,淮安 223300  
陈亮 南京医科大学附属淮安第一医院呼吸科,淮安 223300  
黄茂 南京医科大学附属淮安第一医院呼吸科,淮安 223300  
孟自力 南京医科大学附属淮安第一医院呼吸科,淮安 223300 mzl0807@126.com 
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中文摘要:
      目的 探讨伴与不伴有高血压病的重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压波动的特点及相关影响因素。方法 纳入南京医科大学附属淮安第一医院呼吸科2016年8月至2017年12月重度OSAHS患者125例,根据是否合并高血压分为高血压组(n=64)及血压正常组(n=61)。行多导睡眠图(PSG)检测时,同步测量脉搏传导时间 (PTT)以行连续的动态血压监测。仰卧位清醒状态下,通过袖带测量血压,达到连续3个稳定血压测量值后行血压定标,血压及脉搏变化融合于PSG中。以呼吸事件发生时收缩压最高值与最低值的差值作为呼吸暂停事件相关血压波动幅度(△BP);以每小时△BP>10 mmHg(1 mmHg=0.133 kPa)次数作为血压波动频率(血压指数)。为进一步分析微觉醒及缺氧对血压波动的影响,将所有受试者整夜的呼吸暂停事件进行分类:A类,呼吸暂停事件仅伴有缺氧;B类,呼吸暂停事件仅伴有微觉醒;C类,呼吸暂停事件同时伴有微觉醒及缺氧,比较三类不同呼吸事件引起的△BP。采用SPSS 16.0统计软件进行数据处理。高血压组及血压正常组各项参数比较采用独立样本t检验。三类呼吸暂停事件的比较(A类、B类、C类)采用卡方检验。考察变量之间的相互关系首先使用Pearson相关分析,再行逐步多元回归分析。结果 高血压组的睡眠呼吸紊乱指标明显高于血压正常组;与血压正常组相比,高血压组的△BP和血压指数明显增高[(15.4±4.5) vs(10.9±2.6)mmHg;(57.0±16.5) vs(22.7±12.0)次/h,均P<0.001]。分析整夜呼吸事件提示A类呼吸事件的△BP明显大于B类[高血压组:(15.4±4.9) vs(11.9±3.8) mm Hg;血压正常组:(10.6±3.1) vs(9.5±2.4)mm Hg,均P<0.001],而C类中的△BP明显高于A类及B类(均P<0.001)。回归分析表明,与其他睡眠呼吸紊乱指数相比,血压指数(清醒期:r2=0.454, P<0.001;睡眠期:r2=0.470, P<0.001)及脉搏血氧饱和度(SpO2)<90%累计时间(r2=0.051, P<0.001;睡眠期:r2=0.073, P<0.001)与血压平均水平更相关。结论 在重度OSAHS中,高血压病的发生与夜间血压变异性增高及缺氧时间密切相关;微觉醒及缺氧均可引起血压的急剧增高,而缺氧占有主导地位。
英文摘要:
      Objective To investigate the features and relative factors of blood pressure variability (BPV) in patients suffering from severe obstructive sleep apnea hypopnea syndrome (OSAHS) with and without hypertension. Methods A total of 125 patients with severe OSAHS in our hospital from August 2016 to December 2017 were divided into hypertensive group (n=64) and normotensive group (n=61). Blood pressure (BP) was continuously monitored and measured via pulse transit time (PTT) during polysomnography (PSG) and calibrated when 3 consecutive stable supine cuff values were obtained with patients in a conscious state. Variations in BP and pulse were incorporated in PSG. The amplitude of BP fluctuation (ΔBP) was reflected by the difference between the peak and bottom values of post apneic SBP recorded during an obstructive respiratory event, and the number of ΔBP>10 mmHg(1 mmHg=0.133 kPa)per hour of sleep time was used as indicator for frequency of significant BP fluctuations (BP index). To explore the effects of arousal and hypoxia on BP fluctuations, nocturnal respiratory events were classified into three types:type A with only oxygen desaturation; type B with arousal but without oxygen desaturation; and type C with both arousal and oxygen desaturation. △BP was compared between 3 types. SPSS statistics 16.0 was used for data analysis, and all data were expressed as mean±standard deviation. The independent sample Student′s t test was used for comparison between the groups and Chi-square test for comparison between the 3 types of apnea events. Pearson′s correlation and then a stepwise multiple regression analysis were performed to investigate the relationships between variables. Results Compared with the normotensive group, the hypertensive group had more severe sleep-disordered breathing (SDB) and significant higher ΔBP [(15.4±4.5) vs (10.9±2.6) mmHg] and BP index [(57.0±16.5) vs (22.7±12.0) times/h] (P<0.001 in both). Analysis of the nocturnal respiratory events showed that ΔBP were remarkably greater following type A than type B in hypertensive group[(15.4±4.9) vs (11.9±3.8) mmHg] and normotensive group [(10.6±3.1) vs (9.5±2.4) mmHg] (P<0.001 in both), and that ΔBP following type C were significantly higher than both type A and type B. A stepwise multiple regression equation demonstrated that the mean level of BP had a higher correlation with BP index [awake interval:r2=0.454, P<0.001; sleep interval:r2=0.470, P<0.001)] and the percentage of sleep time with pulse oxygen saturation (SpO2) <90% (awake interval:r2=0.051, P<0.001; sleep interval:r2=0.073, P<0.001) than with other sleep disorder parameters. Conclusion In the patients with severe OSAHS, the occurrences of hypertension are closely associated with increased nocturnal blood pressure variability (BPV) and hypoxic duration and can be induced by both hypoxia and arousal, with hypoxia being a dominant factor.
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