老年高血压并发阻塞性睡眠呼吸暂停综合征患者心率和血压变异性及家庭无创正压通气的干预研究  

Elderly hypertension patients with obstructive sleep apnea syndrome and heart rate and blood pressure variability and the intervention effects of home-based continuous positive airway pressure therapy

作　　者：徐少东 周炳凤 班向阳 刘菲菲 周海凤 许晴鹤 Xu Shaodong;Zhou Bingfeng;Ban Xiangyang;Liu Feifei;Zhou Haifeng;Xu Qinghe(Department of Cardiovascular Medicine,the Third Affiliated Hospital of Anhui Medical University,Hefei 230001,China;Polysomnography Laboratory,Department of Respiratory Medicine,the Third Affiliated Hospital of Anhui Medical University,Hefei 230001,China;ECG Division,the Third Affiliated Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学第三附属医院(合犯市滨湖医院)心血管内科,合肥230001 [2]安徽医科大学第三附属医院(合肥市滨湖医院)呼吸内科睡眠呼吸监测室,合肥230001 [3]安徽医科大学第三附属医院(合肥市滨湖医院)心电图室,合肥230001

出　　处：《中华老年医学杂志》2019年第10期1121-1125,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年高血压并发阻塞性睡眠呼吸暂停综合征(OSAHS)患者睡眠呼吸暂停程度与心律失常、心率变异性(HRV)、血压变异性(BPV)的相关性及家庭无创正压通气(CPAP)的干预效果。方法前瞻性研究,122例老年高血压并发OSAHS的患者,依据睡眠呼吸暂停低通气指数(AHI)分为OSAHS轻度组42例(5次/h≤AHI≤15次/h)、中度组40例(15次/h<AHI≤30次/h)和重度组40例(AHI>30次/h)。观察入选患者于家庭CPAP治疗前和治疗3个月后动态心电图、动态血压等指标变化。比较家庭CPAP治疗前各组组间及治疗前后心律失常发生率、HRV、BPV等指标。结果治疗前,与OSAHS轻度组患者比较,中度组、重度组患者房性期前收缩、房性心动过速、室性期前收缩发生率高(均P<0.01)。与OSAHS轻度组比较,中度和重度组患者HRV指标RR间期标准差、RR间期差均方根、RR间期与平均RR间期>50 ms的个数占总数的百分比、每5 min心搏RR间期均值标准差及心率减速力增高(均P<0.05),且以重度组最为明显。中度和重度组患者BPV指标24 h收缩压标准差、24 h舒张压标准差、日间收缩压标准差、夜间收缩压标准差及非杓型血压发生率均增高(P<0.05),且以重度组最为明显,与中度组比较差异亦有统计学意义(P<0.05)。经家庭CPAP治疗后,除频域指标高频与低频比值各组患者比较差异无统计学意义(均P>0.05),其余指标均明显改善,且以重度组最为明显。非杓型血压节律发生率重度组改善最为明显[21例(52.5%)比8例(20.0%),χ2=5.83,P<0.05]。结论老年高血压并发OSAHS患者,随睡眠呼吸暂停程度加重,心律失常如房性期前收缩、房性心动过速、室性期前收缩等发生率增加,且HRV、BPV增大。家庭CPAP治疗能改善上述指标,是治疗老年高血压并发OSAHS有效方法。Objective To study the correlation of the degree of sleep apnea with arrhythmia,heart rate variability(HRV)and blood pressure variability(BPV)in elderly patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and to investigate the intervention effects of home-based continuous positive airway pressure(CPAP)treatment.Methods A total of 122 elderly hypertension patients with OSAHS were recruited in the prospective study.Patients were divided into three groups according to the sleep apnea hypopnea index(apnea hypopnea index,AHI):the mild OSAHS group(5 times/h≤AHI≤15 times/h,n=42),moderate OSAHS group(15 times/h<AHI≤30 times/h,n=40)and severe OSAHS group(AHI>30 times/h,n=40).All patients took ambulatory electrocardiogram and ambulatory blood pressure examinations before and after three months of CPAP treatment.The incidences of arrhythmia,HRV and BPV indexes of each group before and after CPAP treatment were compared between the groups.Results The incidences of premature atrial contraction,atrial tachycardia and premature ventricular beats were higher in the moderate and severe OSAHS groups than in the mild OSAHS group(P<0.01).Compared with the mild OSAHS group,the RR interval standard deviation(SDNN),root mean square of successive differences(rMSSD),proportion of patients with consecutive RR-interval differences greater than 50 ms(PNN5),standard deviation of the averaged normal RR intervals for all 5 min segments and deceleration capacity of rate increased in the moderate and severe OSAHS groups(P<0.05),and the increases were more obvious in the severe group.Compared with the mild OSAHS group,the standard deviation of 24-h systolic blood pressure,standard deviation of 24-h diastolic blood pressure,standard deviation of daytime systolic blood pressure,standard deviation of nighttime systolic blood pressure and incidence of non-dipper hypertension increased in the moderate and severe OSAHS groups(P<0.05),with the increases were more obvious in the severe group,and the differences was significant between t

关 键 词：高血压 睡眠呼吸暂停 阻塞性 间歇正压通气 

分 类 号：R54[医药卫生—心血管疾病]