阻塞性睡眠呼吸暂停低通气综合征对血压的影响  

Influence of obstructive sleep apnea-hypopnea syndrome on blood pressure

作　　者：朱鹏立[1,2,3] 卓秀萍[1,2,3] 余惠珍[1,2,3] 周婵娟[1,2,3] 林小冰[1,2,3] 

机构地区：[1]福建省立医院 [2]福建省临床老年病研究所 [3]福建医科大学省立临床医学院,福建福州350001

出　　处：《心血管康复医学杂志》2012年第4期353-357,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：福建省科技厅重点项目(2010y0013)

摘　　要：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。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,P0.01 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（P0.01 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%,P0.01）,and significant decrease in ratio of sober time after falling asleep in total sleeping time（22.83% vs.12.90%,P0.05）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 decre

关 键 词：睡眠呼吸暂停 阻塞性 高血压 血压 

分 类 号：R563.909[医药卫生—呼吸系统]