OSA患者低氧事件诱发的血压变异性与血管内皮功能的相关性研究  

The association of blood pressure variability induced by hypoxia events and vascular endothelial function in OSA patients

作　　者：沈佳妮 苏梅 孙博 张文辉 丁宁 徐靖 SHEN Jiani;SU Mei;SUN Bo;ZHANG Wenhui;DING Ning;XU Jing(Department of Respiratory and Critical Care Medicine,the Affiliated Huai’an NO.1 People’s Hospital of Nanjing Medical University,Huai’an 223300;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]南京医科大学附属淮安第一医院呼吸与危重症医学科,江苏淮安223300 [2]南京医科大学第一附属医院呼吸与危重症医学科,江苏南京210029 [3]徐州医科大学附属医院呼吸与危重症医学科,江苏徐州221000

出　　处：《南京医科大学学报（自然科学版）》2024年第4期511-516,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2020YFC2005300)。

摘　　要：目的:探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者夜间低氧事件诱发的血压变异性与血管内皮功能之间的相关性。方法:选取2022年2月—2023年4月分别就诊于南京医科大学附属淮安第一医院等3家不同医院睡眠医学中心的131例中重度OSA患者作为研究对象。在行多导睡眠监测(polysomnography,PSG)时同步行连续无创血压监测,计算低氧事件诱发的血压变异性;以低氧事件发生时的收缩压最高值与最低值的差值作为血压波动的幅度(ΔBP);以睡眠状态下每小时ΔBP≥10 mmHg的次数/氧减指数(oxygen desaturation index,ODI)反映低氧事件诱发血压波动百分比。使用血流介导的内皮依赖性血管舒张功能(flow-mediated dilation,FMD)反映血管内皮功能,并根据FMD值分为内皮功能正常组(70例)及内皮功能障碍组(61例)。分析比较两组血压变异性相关指标,探讨血压变异性的相关因素。结果:两组患者年龄、性别、体重指数、疾病严重程度等差异无统计学意义。内皮功能障碍组的夜间收缩压峰值及舒张压峰值、ΔBP、血压波动百分比及内皮素-1均显著高于内皮功能正常组[(152.0±7.2)mmHg vs.(148.1±8.8)mmHg;(89.8±5.7)mmHg vs.(87.5±6.6)mmHg;(15.3±2.9)mmHg vs.(13.3±2.7)mmHg;(63.5±14.3)%vs.(44.8±10.7)%;(50.7±7.0)ng/L vs.(47.8±8.5)ng/L,P均<0.05]。在校正年龄等基线资料后,回归方程显示夜间收缩压峰值,血压波动百分比及血压波动幅度均与FMD显著相关(P均<0.05)。结论:对于中重度OSA患者,夜间低氧事件诱发的血压变异性增高与血管内皮功能障碍密切相关。Objective:To explore the correlation between blood pressure variability(BPV)and vascular endothelial function induced by nocturnal hypoxia events in obstructive sleep apnea(OSA)patients.Methods:Between February 2022 and April 2023,a total of 131 moderate to severe OSA patients were studied from the departments of Sleep Medicine Centers in three different hospitals,including the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University,etc.Continuous non-invasive blood pressure(BP)monitoring was performed simultaneously during polysomnography(PSG)to calculate BPV induced by hypoxic events,the gap between the peak value of systolio blood pressure(SBP)and the lowest SBP during a hypoxia event reflects the amplitude of BP fluctuation(ΔBP);the number of times ΔBP≥10 mmHg per hour/oxygen desaturation index(ODI)indicates the percentage of hypoxiainduced BP fluctuation.Endothelial function was assessed by flow-mediated dilation(FMD),and patients were divided into normal endothelial function group(n=70)and endothelial dysfunction group(n=61)according to the FMD value.The study analyzed and compared the BPV parameters between the two groups,aiming to explore the factors associated with BPV.Results:There were no significant differences between the two groups of patients in age,sex distribution,body mass index,and OSA severity.Compared with the normal endothelial function group,the endothelial dysfunction group exhibited higher Bnocturnal systolic peak BP[(152.0±7.2)mmHg vs(.148.1±8.8)mmHg],nocturnal diastolic peak BP[(89.8±5.7)mmHg vs(.87.5±6.6)mmHg],ΔBP[(15.3±2.9)mmHg vs.(13.3±2.7)mmHg],the percentage of BP fluctuation[(63.5±14.3)%vs(.44.8±10.7)%,all P<0.05],and endothelin-1[(50.7±7.0)ng/L vs.(47.8±8.5)ng/L,P<0.05].After adjusting the baseline data of patients,the line regression model showed that the nocturnal SBP peak,the percentage of BP fluctuation,andΔBP were all positively correlated with FMD(all P<0.05).Conclusion:For moderate-to-severe OSA patients,the elevation of BPV induced by n

关 键 词：睡眠呼吸暂停 阻塞性 血压变异性 内皮功能 横断面研究 

分 类 号：R563.8[医药卫生—呼吸系统]