男性高血压伴阻塞性睡眠呼吸暂停低通气综合征患者的心律失常和血压水平分析  

Analysis of arrhythmia and blood pressure in male hypertension patients complicated with obstructive sleep apnea hypopnea syndrome

作　　者：周绮[1] 余振球[1] 吉庆伟[2] 

机构地区：[1]首都医科大学附属北京安贞医院高血压科,100029 [2]首都医科大学附属北京安贞医院急诊危重症中心,100029

出　　处：《中国医药》2016年第8期1144-1148,共5页China Medicine

基　　金：国家自然科学基金（81160045）

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对原发性高血压（EH）患者心律失常和血压水平的影响。方法选取2012年10月至2015年11月在首都医科大学附属北京安贞医院高血压科住院的30～60岁男性EH患者282例，所有患者均行夜间多导睡眠监测，根据睡眠呼吸暂停低通气指数（AHI）分为EH组（AHI〈5次／h，97例）和EH伴OSAHS组（AHI〉5次／h，185例），EH伴OSAHS组包括EH伴轻度OSAHs（AHI5～20次／h）82例、EH伴中度OSAHS（AHI21～40次／h）45例及EH伴重度OSAHS（AHI≥40次／h）58例。观察所有患者心律失常的发生情况；采用长程动态心电图记录心电变化。采用24h动态血压监测同步记录所有患者的血压情况，包括日间平均收缩压（DABPS）、日间平均舒张压（DAPBD）、夜间平均收缩压（NABPS）、夜间平均舒张压（NABPD）及血压变异性。比较2组患者的心律欠常发生率、血压水平及昼夜节律。结果EH伴OSAHS组心律失常的发生率明显高于EH组[56．8％（105／185）比22．7％（22／97），P〈0．05]；EH伴中度及重度OSAHS患者低危及高危心律失常的发生率均明显高于EH伴轻度OSAHS者[88．9％（40／45）、89．7％（52／58）比67．1％（55／82），35．6％（16／45）、55．2％（32／58）比12．2％（10／82），P〈0．05]。EH伴OSAHS组DABPS、DABPD、NABPS、NABPD及非杓型血压者比例均明显高于EH组[（139±16）mmHg（1mmHg=0．133kPa）比（130±12）mmHg，（88±12）mmHg比（81±10）mmHg，（134±17）mmHg比（122±12）mmHg，（83±13）mmHg比（75±10）mmHg，56．8％（105／185）比27．8％（27／97），均P〈0．05]；EH伴重度OSAHS患者DABPD及NABPD明显高于EH伴中度及轻度OSAHS者[（93±9）mmHg比（87±11）、（83±12）mmHg，（90±10）mmHg比（81±13）、（77±11）mmHg]，NABPS及非杓型血压者比例明显高于EH伴轻度OSAHS者[（138±18）mmHg比（130±16）mmHg，81．0％�Objective To analyze the effect of obstructive sleep apnea hypopnea syndrome （OSAHS） on arrhythmia and blood pressure in patients with essential hypertension（EH）. Methods Totally 282 male patients aged 30-60 with EH from October 2012 to January 2015 in Beijing Anzhen Hospital, Capital Medical University were randomly selected. All patients had polysomnography（PSG） and they were divided into 2 groups according to apnea bypopnea index（AHI） ： EH group （ 97 cases, AHI 〈 5 times/h） and EH complicated with OSAHS group （ EH ＋ OSAHS group, 185 cases, AHI 〉15 times/h） ; the EH ＋ OSAHS group included EH complicated with mild, moderate and severe OSAHS（EH ＋ mild OSAHS, EH ＋ moderate OSAHS and EH ＋ severe OSAHS） respectively 82, 45 and 58 cases. The occurrence of arrhythmia was observed and the dynamic electrocardiogram was recorded. Blood pressures were monitored by dynamic monitoring device in 24 h; the day average systolic blood pressure （DABPS）, day average diastolic pressure（ DABPD）, night average systolic blood pressure（ NABPS）, night average diastolic blood pressure （ NABPD ） and blood pressure variability were recorded. Incidences of arrhythmia,levels and circadian rhythms of blood pressure were analyzed between groups. Results The incidence of arrhythmia in the EH ＋ OSAHS group was significantly higher than that in the EH group [ 56. 8% （ 105/185 ） vs 22. 7% （22/97）, P 〈 0. 05 ] ; incidences of low risk arrhythmia and high risk arrhythmia in EH ＋ moderate OSAHS and EH ＋ severe OSAHS patients were all significantly higher than those in EH ＋ mild OSANS patients [ 88.9% （40/45） ,89. 7% （52/58） vs 67. 1% （55/82）; 35.6% （16/45）, 55.2% （32/58） vs 12. 2% （10/82）, P 〈 0. 05 ]. Levels of DABPS, DABPD, NABPS, NABPD and the proportion of non-dipper blood pressure pattern in EH ＋ OSAHS group were all significantly higher than those in EH group[ （ 139 ± 16） mmHg vs （ 130 ±12） mmHg, （88 ±12） mmHg vs （81 ±10�

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 心律失常 高血压 多导睡眠图 

分 类 号：R544.1[医药卫生—心血管疾病]