高血压患者夜间平均舒张压与中重度阻塞性睡眠呼吸暂停低通气综合征的关系  

Relationship between night-time mean diastolic blood pressure and moderate-severe obstructive sleep apnea hyponea syndrome in patients with hypertension

作　　者：黄泰 姚晓光[1] 李胜[1] 汪迎春[1] 王磊[1] 李南方[1] HUANG Tai;YAO Xiao-guang;LI Sheng;WANG Ying-chun;WANG Lei;LI Nan-fang(Hypertension Center of the People’s Hospital of Xinjiang Uygur Autonomous Region,National Health Committee Key Laboratory of Hypertension Clinical Research,Urumqi Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院高血压中心新疆高血压研究所国家卫生健康委高血压诊疗研究重点实验室,新聩乌鲁木齐830001

出　　处：《中华高血压杂志》2020年第5期426-432,共7页Chinese Journal of Hypertension

基　　金：新疆维吾尔自治区医学联合基金项目(2016D01C114);国家卫生健康委高血压诊疗研究重点实验室资助项目。

摘　　要：目的探讨高血压患者夜间平均舒张压与中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关性及其诊断价值。方法连续纳入2018年9-11月新疆维吾尔自治区人民医院高血压诊疗中心就诊的144例住院患者,进行多导睡眠监测(PSG)、动态血压监测(ABPM),收集人体测量指标,采用No-Apnea模型、NoSAS评分、STOP-BANG问卷筛查OSAHS。入选患者根据呼吸暂停低通气指数(AHI)分为非中重度OSAHS组(AHI≤15次/h,n=89)和中重度OSAHS组(AHI>15次/h,n=55)。采用受试者工作特征(ROC)曲线评估夜间平均舒张压以及现有量表对中重度OSAHS的诊断价值。DeLong方法比较各指标ROC曲线之间差异是否有统计学意义,并计算敏感度、特异度、阳性预测值、阴性预测值、约登指数、准确率、Kappa值。结果入选患者年龄(45.4±11.1)岁,其中男性102例,女性42例。以AHI>15次/h为界值,夜间舒张压诊断中重度OSAHS的曲线下面积(AUC)为0.725,最佳截点为>86 mm Hg(约登指数0.463)。敏感度、特异度、阳性预测值、阴性预测值分别为63.2%、83.1%、70.0%、78.7%;约登指数(0.463)、准确率(75.7%)、Kappa值(0.476)较上述3种现有量表高。与No-Apnea模型串联后,敏感度、特异度、阳性预测值、阴性预测值、约登指数、准确率及Kappa值分别为61.8%、91.0%、81.0%、79.4%、0.528、79.8%、0.553,除敏感度较前略减少,余预测指标较前均有提高。结论夜间平均舒张压在高血压人群中与中重度OSAHS相关,具有较好的诊断价值,与No-Apnea模型串联后可以提高诊断中重度OSAHS的能力。Objective To explore the relationship between nocturnal mean diastolic blood pressure and moderate-severe obstructive sleep apnea hyponea syndrome(OSAHS)in hypertensive patients and evaluate the value of nocturnal mean diastolic blood pressure in diagnosing moderate-severe OSAHS.Methods Clinical data of 144 hypertensives who underwent polysomnography(PSG),ambulatory blood pressure monitoring(ABPM)in our hospital from September 2018 to November 2018 were recruited.Datas of STOP-Bang questionnaire,No-Apnea model and anthropometric measurements were collected,as well as NoSAS(neck,obesity,snoring,age,sex)score.According to apnea hypopnea index(AHI),the patients were divided into non moderate-severe OSAHS group(AHI≤15 times/h,n=89)and moderate-severe OSAHS group(AHI>15 times/h,n=55).The receiver operating characteristics(ROC)curve was applied for evaluating the diagnostic value of nocturnal mean diastolic blood pressure and present tools for screening moderate-severe OSAHS.DeLong method was used to determine whether there was statistical differences among each indicators’ROC curve.Sensitivity,specificity,positive predictive value,negative predictive value,Youden index,accuracy,Kappa value were also calculated for each indicator.Results There were 102 males and 42 females recruited with mean age of(45.4±11.1)years.When the cutoff point of AHI was 15 times/h,the AUC of nocturnal mean diastolic blood pressure was 0.725 with the best cutoff point as 86 mm Hg(Youden index 0.463).Sensitivity,specificity,positive predictive value,negative predictive value of nocturnal mean diastolic blood pressure at the cutoff point were 63.2%,83.1%,70.0%,and 78.7%,respectively.The Youden index,accuracy and Kappa values were better than those of the present screening tools.After being connected to the No-Apnea model,the sensitivity,specificity,positive predictive value,negative predictive value,Yoden index,accuracy and Kappa value were 61.8%,91.0%,81.0%,79.4%,0.528,79.8%,0.553,respectively.All of the predictive indicators have been im

关 键 词：高血压 动态血压监测 阻塞性睡眠呼吸暂停低通气综合征 

分 类 号：R544.1[医药卫生—心血管疾病] R766[医药卫生—内科学]