阻塞性睡眠呼吸暂停对血压的影响  

Effect of Obstructive Sleep Apnea Syndrome on Human Blood Pressure

作　　者：宋璐[1] 王蓓[1] 王强[1] 刘卓拉[1] 

机构地区：[1]山西医科大学第二医院呼吸科,山西省太原市030001

出　　处：《中国循环杂志》2011年第4期275-278,共4页Chinese Circulation Journal

基　　金：山西省留学归国人员科研项目(项目下达文号201014;项目编号100)

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。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≤AHI20）,Moderate subgroup,n=29,（20≤AHI40）,Severe I subgroup,n=24,（40≤AHI60）,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,P0.05 respectively.In OSAS group,compared with Mild subgroup,the patients had increased diastolic blood pressure in Moderate,Severe I and Severe Ⅱ subgroups,P0.05respectively.In OSAS with hypertension group,compared with Mild subgroup,the patients had increased systolic and diastolic blood pressure in Moderate and Severe Ⅱ subgroups,P0.05 respectively.In OSAS group,the diastolic blood pressure positively related to AHI in Mild subgroup（r=0.69,P0.05）;the mean arterial pressure negatively related to minimum oxygen saturation in Sereve Ⅱ subgroup（r=-0.60,P0.05）.In OSAS with hypertension group,the systolic blood pressure positively correlated with the longest apnea time in Mild subgroup（r=0.60,P0.05）;the systolic blood pressure positively correlated with the longest apnea time（r=0.73,P0.05） and the diastolic blood pressure,mean arterial pressure positively correlated with AHI（r=0.88 and 0.86,P0.05 respectively） in Moderate subgroup;the diastolic blood pressure,mean arterial pressure negatively correlated with AHI（r=-0.58 and-0.70,P0.05 respectively） and the diastolic blood pressure positively correlated with minimu

关 键 词：阻塞性睡眠呼吸暂停 高血压 

分 类 号：R541[医药卫生—心血管疾病]