阻塞性睡眠呼吸暂停低通气综合征对血压的影响

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对血压的影响。方法：入选112名患者,行多导睡眠监测,根据是否伴有高血压及OSAHS呼吸暂停低通气指数（AHI）〉20次/min,定义为中重度OSAHS],随机分为四组,血压正常＋轻度OSAHS组（30例）、血压正常＋中重度OSAHS组（25例）、高血压＋轻度OS-AHS组（22例）、高血压＋中重度OSAHS组（35例）。比较一般临床资料、血压参数、睡眠结构、血氧参数。结果：1.高血压患者中,与轻度OSAHS组比较,中重度OSAHS组的初醒时舒张压明显升高（93.45±12.24）mmHg比（100.31±9.97）mmHg],睡前、初醒时脉压（58.41±15.52）mmHg比（47.71±11.46）mmHg,（55.77±17.42）mmHg比（41.51±11.86）mmHg]明显降低（P〈0.01）;在血压正常患者中,上述各血压参数在中重度OSAHS组与轻度OSAHS组间均无显著性差异;2.与轻度OSAHS组比较,中重度OSAHS组的AHI、低氧指数和血氧饱和度〈90%时间均明显增加,平均血氧饱和度、最低血氧饱和度明显降低（P〈0.01）;3.高血压患者中,与轻度OSAHS组比较,中重度OSAHS组的非快速动眼Ⅱ期占总睡眠时间比例明显增加（37.55%比47.13%,P〈0.01）、入睡后清醒时间占总睡眠时间比例减少（22.83%比12.90%,P〈0.05）。结论：OSAHS对高血压患者血压有显著影响,表现在初醒时舒张压升高,睡前、初醒时脉压降低,并随着OSAHS病情加剧而加重。OSAHS患者夜间发生缺氧,这可能是合并OSAHS的高血压患者舒张压波动的重要机制之一。

Influence of obstructive sleep apnea-hypopnea syndrome on blood pressure

Objective: To explore influence of obstructive sleep apnea-hypopnea syndrome(OSAHS) on blood pressure.Methods: A total of 112 patients underwent polysomnography monitoring.According to complicated with essential hypertension(EH) and OSAHS or not;and moderate-severe OSAHS was defined as apnea hypopnea index(AHI)>20 times/min,all patients were randomly divided into four groups: normal blood pressure + mild OSAHS group(n=30),normal blood pressure + moderate-severe OSAHS group(n=25),EH + mild OSAHS group(n=22) and EH + moderate-severe OSAHS group(n=35).All indexes were analyzed and compared among all groups.Results:1.Among EH patients,compared with mild OSAHS group,there were significant increase in diastolic blood pressure when initial awakening (93.45±12.24) mmHg vs.(100.31±9.97) mmHg]and significant decrease in pulse pressure(PP) before sleep and when initial awakening before sleep:(58.41±15.52) mmHg vs.(47.71±11.46) mmHg,initial awakening:(55.77±17.42) mmHg vs.(41.51±11.86) mmHg,P<0.01 all]in moderate-severe OSAHS group;among patients with normal blood pressure,there were no significant difference in above indexes between mild OSAHS group and moderate-severe OSAHS group;2.Compared with mild OSAHS group,there were significant increase in AHI,hypoxia index and saturation of arterial blood oxygen(SaO2) <90% time,and significant decrease in mean SaO2 and minimum SaO2 in moderate-severe OSAHS group(P<0.01 all);3.Among EH patients,compared with mild OSAHS group,there were significant increase in ratio of non rapid-eye movement stage Ⅱ in total sleeping time(37.55% vs.47.13%,P<0.01),and significant decrease in ratio of sober time after falling asleep in total sleeping time(22.83% vs.12.90%,P<0.05)in moderate-severe OSAHS group.Conclusion: The OSAHS possesses significant influence on blood pressure in EH patients,it presented as diastolic blood pressure significantly increase when initial awakening,and PP significantly decrease before sleep and when initial awakening,and the more severe OSAHS is,the more severe these changes are;there is hypoxia in OSAHS patients at night,which may be an important mechanism of fluctuation of diastolic blood pressure in EH patients with OSAHS.