短期体位治疗对体位相关性阻塞性睡眠呼吸暂停合并高血压的治疗效果  

Usage of short-term postural therapy in patients with positional obstructive sleep apnea and hypertension

作　　者：汪思敏 姚晓光[1] 杨文博 毕云伟[1] 孙乐[1] 李南方[1] WANG Si-min;YAO Xiao-guang;YANG Wen-bo;BI Yun-wei;SUN Le;LI Nan-fang(Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Hypertension Institute,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,新疆乌鲁木齐830001

出　　处：《中华高血压杂志》2022年第7期645-651,共7页Chinese Journal of Hypertension

基　　金：新疆维吾尔自治区人民医院院内课题(20200302)。

摘　　要：目的评价短期体位治疗对体位相关性阻塞性睡眠呼吸暂停(POSA)合并高血压患者的影响。方法连续纳入2020年9-12月就诊于新疆维吾尔自治区人民医院高血压中心年龄≥18岁的高血压患者,所有患者完善多导联睡眠监测、动态血压等,共纳入符合POSA诊断标准并完成“网球背垫法”一整夜(治疗时间不少于7 h)体位治疗的患者60例。对比治疗前后患者睡眠参数及血压水平变化。结果与体位治疗前比较,体位治疗当晚患者仰卧位睡眠时间(TST_(仰))[80.8(40.4~118.0)比149.1(87.7~228.1)min,Z=-4.708,P<0.001]、睡眠呼吸暂停低通气指数(AHI)[10.9(6.7~17.1)比17.0(10.2~24.2)次/h,Z=-4.388,P<0.001]、仰卧位AHI(AHI仰)[(30.5±22.3)比(41.0±23.7)次/h,t=4.326,P<0.001]、血氧饱和度(SaO_(2))低于90%的睡眠时间(TST90)[11.9(4.4~31.0)比23.0(4.9~78.7)min,Z=-3.178,P=0.001]、晨起舒张压[(87.9±10.1)比(91.9±11.4)mm Hg,t=3.135,P=0.003]降低,平均SaO_(2)(MSaO_(2))[93.0%(92.0%~94.0%)比92.0%(91.0%~93.0%),Z=-4.624,P<0.001]和最低SaO_(2)[82.0%(79.0%~85.0%)比81.0%(77.0%~84.0%),Z=-3.048,P=0.002]升高;治疗前后晨起收缩压水平[(139.6±12.6)比(142.6±15.3)mm Hg]差异无统计学意义(t=1.781,P=0.080)。相关性分析显示:TST_(仰)变化(ΔTST_(仰))与AHI变化(ΔAHI)呈正相关(r_(s)=0.291,P=0.036),与AHI仰变化(ΔAHI仰)呈负相关(r_(s)=-0.466,P=0.001)。多重线性回归分析结果显示,ΔTST_(仰)是体位治疗前后AHI改变的影响因素(B=0.412,P=0.004)。结论短期体位治疗能够有效降低POSA合并高血压患者睡眠呼吸紊乱事件,改善夜间低氧及晨起舒张压。Objective To evaluate the effect of postural therapy in patients with positional obstructive sleep apnea(OSA)and hypertension.Methods Hypertensive patients aged 18 years or above who visited the hypertension center of the People's Hospital of Xinjiang Uygur Autonomous Region from September to December 2020 were continuously enrolled.All patients completed multi-lead sleep monitoring and ambulatory blood pressure,etc.Finally,a total of 60 patients who met the diagnostic criteria of position related obstructive sleep apnea(POSA)and completed the"tennis back pad method"postural therapy overnight were included for analysis.The changes of sleep parameters and blood pressure levels before and after treatment were compared.Results Supine sleep time[80.8(40.4-118.0)vs 149.1(87.7-228.1)min,Z=-4.708,P<0.001],total sleep apnea hypopnea index(AHI)[10.9(6.7-17.1)vs 17.0(10.2-24.2)times/h,Z=-4.388,P<0.001],supine AHI[(30.5±22.3)vs(41.0±23.7)times/h,t=4.326,P<0.001],sleep time with blood oxygen saturation(SaO_(2))<90%(TST90)[11.9(4.4-31.0)vs 23.0(4.9-78.7)min,Z=-3.178,P=0.001]and morning diastolic blood pressure[(87.9±10.1)vs(91.9±11.4)mm Hg,t=3.135,P=0.003]were significantly decreased after postural therapy,while the mean SaO_(2)[93.0%(92.0%-94.0%)vs 92.0%(91.0%-93.0%),Z=-4.624,P<0.001]and the lowest SaO_(2)[82.0%(79.0%-85.0%)vs 81.0%(77.0%-84.0%),Z=-3.048,P=0.002]were significantly increased.The level of systolic blood pressure[(139.6±12.6)vs(142.6±15.3)mm Hg]in the morning before and after treatment had no significant difference(t=1.781,P=0.080).Correlation analysis showed that the change of TST_(supine)(ΔTST_(supine))was positively correlated with the change of AHI(ΔAHI)(r_(s)=0.291,P=0.036)and negatively correlated with the change of AHIsupine(ΔAHIsupine)(r_(s)=-0.466,P=0.001).Multiple linear regression analysis showed thatΔTST supine was the influencing factor of the change of AHI before and after postural therapy(B=0.412,P=0.004).Conclusion Short-term postural therapy can effectively reduce sleep-disordered bre

关 键 词：高血压 体位相关性阻塞性睡眠呼吸暂停 体位治疗 

分 类 号：R766[医药卫生—耳鼻咽喉科] R544.1[医药卫生—临床医学]