睡眠呼吸暂停与睡眠前后血管内皮功能变化关系的研究  

The Relationship between Obstructive Sleep Apnea Hypopnea Syndrome and Vascular Endothelial Function Variation before and after Sleeping

作　　者：邓峥[1] 孙睿[1] 樊重阳 曹蓉[1] 苗志斌[1] 吕云辉[1] 

机构地区：[1]昆明医科大学附属昆华医院呼吸科,云南昆明650032

出　　处：《昆明医科大学学报》2012年第11期42-48,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学联合专项基金资助项目(2009CD197)

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对血管内皮功能变化的影响.方法根据整夜多导睡眠监测(PSG)、血压测量和病史采集将222例受试者分为:正常对照组与OSHAS患者组.OSAHS组根据有无合并高血压可分为单纯OSAHS组和OSAHS合并高血压组,根据睡眠呼吸暂停低通气指数(AH)I又可分为轻度、中度、重度3组.所有研究对象均于PSG监测当晚睡前及次晨醒后测定四肢血压、脉搏波传导速度(PWV)和血浆内皮素-1(ET-1)、一氧化氮(NO)含量.结果正常对照组睡眠后血浆ET-1、NO、ET-1/NO、PWV、舒张压较睡前无明显改变(P>0.05),收缩压较睡前下降(P<0.01);OSAHS组睡眠后血浆ET-1、ET-1/NO、PWV、收缩压、舒张压均较睡前明显升高,NO则明显降低(P<0.01).单纯OSAHS组与OSAHS合并高血压组比较,2组睡前血浆ET-1、NO、ET-1/NO比值差异无统计学意义(P>0.05),但醒后OSAHS+高血压组的ET-1含量、ET-1/NO比值明显高于单纯OSAHS组(P<0.05及P<0.01),而NO含量则2组差异无统计学意义(P>0.05).轻、中、重度OSAHS组之间比较,各组间睡前醒后的ET-1、NO、PWV均差异有统计学意义(P<0.05),ET-1、PWV随OSAHS严重程度增加呈增高趋势,NO则在中度组最高,重度组反而下降.自身配对比显示,3组醒后ET-1、NO、PWV均较睡前明显变化,但变化的幅度随OSAHS严重程度的不同而有不同.相关分析显示,仅在重度OSAHS患者夜间ET-1、NO的变化与夜间血氧饱和度低于90%的时间占总睡眠时间的百分比(SIT90)相关.结论 OSAHS可引起血管内皮功能指标变化,OSAHS严重程度不同对血管内皮功能的影响幅度不同,OSAHS引起高血压主要与低氧和内皮素升高有关.Objective To explore vascular endothelial function variation in patients with Obstructive Sleep Apnea Hypopnea Syndrome.Methods Based on polysomnography（PSG）,blood pressure（BP）and medical history,222 subjects were divided into two groups：OSAHS patients group and normal control group.Patients in OSAHS patients group were divided into two subgroups：OSAHS with hypertension group and OSAHS without hypertension group.According to sleep apnea hypopnea index（AHI）,patients in OSAHS patients group were divided into three subgroups： mild,moderate and severe OSAHS groups.Blood pressures of limbs,pulse wave velocity（PWV）,endothelin-1（ET-1） levels,nitric oxide（NO） levels were monitored before and after sleeping（pre-PSG monitoring and post-PSG monitoring,respectively）.Results No significant variation of ET-1 levels,NO levels,ET-1/NO ratios,PWV and diastolic blood pressure were found in subjects before and after sleeping in normal control group（P0.05）,whereas systolic blood pressure declined after sleeping（post-PSG）（P0.01）.Significant increase of ET-1levels,ET-1/NO ratios,PWV,systolic blood pressure and diastolic blood pressure after sleeping were observed in OSAHS group（P0.01）,while NO levels decreased significantly after sleeping（P0.01）.There were no significant differences in ET-1 levels,NO levels,ET-1/NO ratios,PWV variation between subgroups of OSAHS patients group（P0.05）,however ET-1 levels,ET-1/NO ratios of OSAHS patients with hypertension were significantly higher before sleeping than those without hypertension（P0.05 and P0.01,respectively）,with no differences in NO levels between two subgroups（P0.05）.Comparison among mild,moderate and severe OSAHS groups,ET-1 levels,NO levels and PWV before sleeping and after waking were significantly different（P0.05）.ET-1 levels and PWV tended to increase along with the increase of OSAHS severity.NO levels were highest in moderate group,whereas declined in severe group.Although ET-1 levels,NO levels,PWV were signifi

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 血管内皮 高血压 

分 类 号：R563.9[医药卫生—呼吸系统]