高血压合并阻塞性睡眠呼吸暂停低通气综合征患者短时血压变异性的影响因素研究  

Short-term Blood Pressure Variability and Related Factors Among Patients With Hypertension and Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：张双双 胡申江[1] ZHANG Shuangshuang;HU Shenjiang(Department of Cardiology,The First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou(310000),Zhejiang,China)

机构地区：[1]浙江大学医学院附属第一医院心内科,浙江省杭州市310000 [2]浙江大学宁波医院(宁波市第一医院)

出　　处：《中国循环杂志》2020年第3期282-287,共6页Chinese Circulation Journal

摘　　要：目的:探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者短时血压变异性(BPV)的影响因素。方法:选择2017年6月至2019年5月在宁波市第一医院心血管科诊治的153例高血压患者,给予多导睡眠呼吸监测及动态血压监测,根据睡眠呼吸暂停低通气指数(AHI)将患者分四组:单纯高血压作为对照组(41例)、高血压合并轻度OSAS组(36例)、高血压合并中度OSAS组(36例)、高血压合并重度OSAS组(40例)。采用因子分析方法提取影响高血压合并OSAS患者短时血压变异性的公因子,进行多元线性回归分析影响高血压合并OSAS患者短时血压变异性的因素。结果:因子分析纳入可能影响高血压合并OSAS患者短时血压变异性的因素,共提取4个公因子:体重指数、OSAS严重程度相关参数、生活行为习惯、年龄及高血压病程;多元线性回归分析显示OSAS严重程度与高血压合并OSAS患者夜间收缩压短时血压变异性(nSBPARV)及夜间舒张压短时血压变异性(nDBPARV)均存在相关性(β=0.277,P<0.05;β=0.360,P<0.05),对于高血压合并OSAS患者nSBPARV的影响因素依次为OSAS严重程度>年龄及高血压病程(分别为β=0.277,P<0.05;β=0.225,P<0.05),对于nDBPARV的影响因素依次为OSAS严重程度>体重指数(分别为β=0.360,P<0.05;β=0.187,P<0.05)。高血压合并轻度、中度、重度OSAS组的nSBPARV、nDBPARV均较对照组大;且高血压合并重度OSAS组的nSBPARV、nDBPARV、日间收缩压短时血压变异性均大于对照组、高血压合并轻度、中度OSAS组,差异均具有统计学意义(P<0.05)。结论:高血压患者合并OSAS时容易出现夜间短时血压变异性增加,OSAS严重程度是高血压合并OSAS患者夜间血压短时变异性增加的主要因素,肥胖、年龄及高血压病程也是重要影响因素。Objectives:To investigate the short-term blood pressure variability and related factors among patients with hypertension and obstructive sleep apnea hypopnea syndrome(OSAS).Methods:153 hypertensive patients,who visited the Cardiovascular Department of the Ningbo First Hospital from June 2017 to May 2019 and underwent polysomnography and 24-h ambulatory BP monitoring,were included in this study.Patients were divided into four groups according to apnea-hypopnea index(AHI):hypertension with mild OSAS(n=36),hypertension with moderate OSAS(n=36),hypertension with severe OSAS(n=40)and hypertension without OSAS as control group(n=41).Factor analysis was employed to identify common factors related to the alterations of short-term blood pressure variability in hypertensive patients with OSAS.Multiple linear regression analysis was used to define the influencing factors of the observed variables.Results:Factor analysis showed that the severity of OSAS,body mass index(BMI),life style,age and course of hypertension were the common factors relating to the short-term blood pressure variability.Multiple linear regression analysis showed that the severity of OSAS was correlated with short-term blood pressure variability of nocturnal systolic blood pressure(SBP)and nocturnal diastolic blood pressure(DBP)in patients with hypertension and OSAS(β=0.277,P<0.05;β=0.360,P<0.05).The contribution according to priority was OSAS>course of hypertension/age for short-term blood pressure variability of nocturnal SBP(β=0.277,P<0.05;β=0.225,P<0.05).The contribution according to priority was OSAS>BMI for the short-term blood pressure variability of nocturnal DBP(β=0.360,P<0.05;β=0.187,P<0.05).average real variabilities of nocturnal SBP and DBP were significantly lower in control group than in hypertension patients with mild,moderate and severe OSAS.Average real variabilities of nocturnal SBP and DBP,day time SBP were significantly higher in the hypertension with severe OSAS group than in control,mild and moderate OSAS groups(P<0.05).Concl

关 键 词：睡眠呼吸暂停低通气综合征 高血压 血压变异性 短时血压变异性 

分 类 号：R541.4[医药卫生—心血管疾病]