Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome  

作　　者：HE Quan-ying FENG Jing ZHANG Xilong LIANG Zong-an HUANG Shao-guang KANG Jian WANG Guang-fa ZHANG Li-qiang MA Li-jun WANG Bei LIN Qi-chang ZHANG Jin-nong LIU Hui-guo LUO Yuan-ming LIU Jian-hong WANG Shi XIAO Gao-hui LU Gan ZHANG Jin FENG Xue-wei CHEN Bao-yuan 

机构地区：[1]Department of Respiratory Diseases,Peking University People’s Hospital,Belling 100044,China [2]Department of Respiratory Diseases,Tianjin Medical University General Hospital,Tianiin 300052,China [3]Department of Respiratory Diseases,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China [4]Department of Respiratory Diseases,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China [5]Department of Respiratory Diseases,Ruijin Hospital,Shanghai Jiao Tbng University School of Medicine,Shanghai 200025,China [6]Department of Respiratory Diseases,First Affiliated Hospita1 ofChina Medical University,Shenyang,Liaoning 110001,China [7]Department of Respiratory Diseases,Peking University First Hospital,Beijing 100034,China [8]Department of Respiratory Diseases,Peking University Third Hospital,Beijing 100191,China [9]Department of Respiratory Diseases,Henan Provincial People’s Hospital,Zhengzhou,Henan 450003,China [10]Department of Respiratory Diseases,Second Affiliated Hospita1 of Shanxi Medical University,Taiyuan,Shanxi 030001,China [11]Department of Respiratory Diseases,First Affiliated Hospital of Fujian Medical University,Fuzhou,Fuiian 350005,China [12]Department of Respiratory Diseases,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,wuhan,Hubei 430022,China [13]Department of Respiratory Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030 China [14]Guangzhou Institute of Respiratory Disease.First Affiliated Hospital of Guangzhou Medical College,Guangzhou,Guangdong 510120,China [15]Department of Respiratory Diseases,Guangxi Zhuang Autonomous Region People’s Hospital,Nanning,Guangxi 530021,China [16]Department of Respiratory Diseases,Central Hospita1 of Shenyang Medical College Shenyang,Liaoning 110024,China [17]Department of Respiratory Diseases,Beijing Gongan Hospital,Beijing 100006,China [18]Department of Respiratory Diseases,Jiangsu Senility Hospital,Nanjing,Jiangsu 210024,

出　　处：《Chinese Medical Journal》2012年第10期1740-1746,共7页中华医学杂志（英文版）

基　　金：This study was supported by the grants from the National Natural Science Foundation of China （No. 30800507, No. 30770934）. All the coauthors from different centers in the name list have made equal contributions to this article. There is no ordering difference. None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

摘　　要：Background The nocturnal nondipping and elevated morning blood pressure （BP） in patients with obstructive sleep apnea syndrome （OSAS） have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. Methods Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points （daytime, evening, nighttime and morning） and polysomnography （PSG） was performed and subjects were classified into four groups by their apnea-hypopnea index （AHI）： control, n=213 with AHI 〈5; mild, n=420 with AHI -〉5 and 〈15; moderate, n=460 with AHI -〉15 and 〈30; and severe, n=1204 with AHI -〉30. SPSS 11.5 software package was used for statistical analysis and figure drawing. Results All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a ＂reversed BP dipping＂ pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. Conclusions OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.Background The nocturnal nondipping and elevated morning blood pressure （BP） in patients with obstructive sleep apnea syndrome （OSAS） have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. Methods Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points （daytime, evening, nighttime and morning） and polysomnography （PSG） was performed and subjects were classified into four groups by their apnea-hypopnea index （AHI）： control, n=213 with AHI 〈5; mild, n=420 with AHI -〉5 and 〈15; moderate, n=460 with AHI -〉15 and 〈30; and severe, n=1204 with AHI -〉30. SPSS 11.5 software package was used for statistical analysis and figure drawing. Results All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a ＂reversed BP dipping＂ pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. Conclusions OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.

关 键 词：obstructive sleep apnea syndrome blood pressure hypertension  dipping  polysomnography apnea-hypopnea index 

分 类 号：R56[医药卫生—呼吸系统]