睡眠障碍性呼吸对老年脑梗死患者血压变异性及短期预后的影响

目的探讨睡眠障碍性呼吸对老年脑梗死血压变异性及短期预后的影响。方法前瞻性纳入2012-06-2019-09在郑州人民医院神经内科二病区住院就诊的老年脑梗死患者226例。按照入院时及入院72 h NIHSS评分结果,按照是否发生终点事件分为进展组和对照组。入院后完成多导睡眠监测及动态血压监测。观察血压变异性及预后的差异,并分层分析不同睡眠紊乱指数下的血压变异性差异。结果进展组与对照组SE、TST、S3+S4/%、REM期睡眠比例及RDI、AHI、收缩压标准差比较,差异有统计学意义(P<0.05)。中高度睡眠呼吸紊乱指数组与对照组比较,高收缩压标准差、非杓型比例明显增多,差异有统计学意义(P<0.05)。结论睡眠呼吸暂停低通气指数、睡眠紊乱指数是预测睡眠障碍性呼吸老年脑梗死患者短期预后的可靠指标,原因可能与睡眠影响血压变异性有关。

Effects of sleep disordered breathing on blood pressure variability and short-term prognosis in elderly patients with cerebral infarction

Objective To explore the effect of sleep disordered breathing on blood pressure variability and short-term prognosis of cerebral infarction.Methods From June 2012 to September 2019,226 patients in the Department of Neurology of Zhengzhou People's Hospital were included prospectively.According to the results of NIHSS scores at admission and 72 hours after admission,the patients were divided into two groups according to whether there was an end point event or not.After admission,polysomnography and ambulatory blood pressure monitoring were completed.The differences of blood pressure variability and prognosis were observed,and the differences of blood pressure variability under different sleep disorder indexes were analyzed.Results The differences of Se,TST,S3+S4/%,REM sleep ratio,RDI,AHI and systolic blood pressure standard deviation between the observation group and the control group were statistically significant(P<0.05).The standard deviation of high systolic blood pressure and the proportion of non dipper type in the middle and high sleep disordered index group were significantly higher than that in the light sleep disordered index group(P<0.05).Conclusion Sleep apnea hypopnea index and sleep disorder index are reliable indexes to predict the short-term prognosis of patients with sleep disordered respiratory infarction.The reason may be that sleep affects blood pressure variability.