持续气道正压通气对合并高血压的重度OSA患者降压效益与夜间短时血压变异性相关性分析  

Correlation analysis between the antihypertensive effect of continuous positive airway pressure in severe obstructive sleep apnea patients with hypertension and nocturnal short-term blood pressure variability

作　　者：孙博 沈佳妮 袁玉洁 万玉姣 徐靖 林海艳 Sun Bo;Shen Jiani;Yuan Yujie;Wan Yujiao;Xu Jing;Lin Haiyan(Department of Respiratory and Critical Care Medicine,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Respiratory and Critical Care Medicine,the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Huaian 223300,China)

机构地区：[1]徐州市中心医院呼吸与危重症医学科,徐州221009 [2]南京医科大学附属淮安第一医院呼吸与危重症医学科,淮安223300

出　　处：《国际呼吸杂志》2024年第11期1250-1256,共7页International Journal of Respiration

基　　金：国家自然科学基金(81900084)。

摘　　要：目的分析持续气道正压通气(CPAP)对合并高血压的重度阻塞性睡眠呼吸暂停(OSA)患者降压效益与夜间短时血压变异性的相关性。方法本研究为类实验研究。采用非随机抽样法, 选取2022年1月至2022年11月就诊于南京医科大学附属淮安第一医院睡眠医学中心的打鼾患者, 根据纳入、排除标准共纳入86例合并高血压的重度OSA患者, 在行多导睡眠图监测时, 同步行连续无创血压监测。计算其夜间短时血压变异性:呼吸事件发生时收缩压最高值与最低值的差值来反映血压波动幅度(ΔSBP);以每小时ΔSBP>10 mmHg(1 mmHg=0.133 kPa)的次数作为血压波动频次。测量CPAP治疗4周后的血压值并根据夜间收缩压下降幅度的中位数, 分为CPAP降压效益欠佳组(<6.7 mmHg)和CPAP降压效益良好组(>6.7 mmHg), 分析夜间短时血压变异性与CPAP降压效益的关系。结果 CPAP降压效益欠佳组43例, 男41例, 女2例, 年龄(42.0±9.5)岁;CPAP降压效益良好组43例, 男40例, 女3例, 年龄(39.6±7.9)岁。2组性别、年龄、诊室血压及夜间舒张压等差异均无统计学意义(均P>0.05)。与CPAP降压效益欠佳组相比, CPAP降压效益良好组表现出较重的低氧血症[平均SpO2:89.0(87.0, 91.0)%比93.0(90.0, 93.0)% , Z=4.02, P<0.001;最低SpO2:63.0(57.0, 69.0)%比73.0(65.0, 80.0)% , Z=4.73, P<0.001]及较高的血压变异性[ΔSBP:17.2(13.9, 21.6)mmHg(1 mmHg=0.133 kPa)比9.4(7.9, 15.0)mmHg, Z=4.65, P<0.001;血压波动频次:(49.8±14.9)次/h比(22.7±13.0)次/h, t=9.00, P<0.001]。夜间(β=0.250, P<0.001)及诊室收缩压(β=0.043, P=0.031)的下降幅度均与血压波动频次呈正相关。另外, 夜间短时血压变异性作为CPAP降压效益的预判指标, 具有较高的敏感度及特异度。ΔSBP最佳截断值为13.85 mmHg, 敏感度和特异度分别为76.74%、74.42%;血压波动频次最佳截断值为38.5次/h, 敏感度和特异度分别为83.72%、86.05%。结论对于合并高血压的重度OSA患者, �Objective:To analyze the correlation between the antihypertensive effect of continuous positive airway pressure(CPAP)and nocturnal short-term blood pressure variability(BPV)in severe obstructive sleep apnea(OSA)patients with hypertension.Methods:This was a quasi-experimental study.By non-random sampling,patients with snoring who visited the Department of Sleep Medicine Center,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from January 2022 to November 2022 were collected.All subjects underwent polysomnography(PSG),and continuous monitoring of full-night blood pressure(BP).Based on the inclusion and exclusion criteria,a total of 86 severe OSA patients with hypertension were recruited.The nocturnal short-term BPV was calculated.Specifically,the gap between the peak postapneic systolic blood pressure(SBP)and the lowest SBP during a respiratory event was calculated to reflect event-related SBP elevation(ΔSBP).The number ofΔSBP>10 mmHg/h(1 mmHg=0.133 kPa)of sleep indicated the frequency of BP fluctuations.Based on the median nocturnal SBP reduction caused by 4 weeks of CPAP treatment,the cohort was divided into two groups:the CPAP responder group(>6.7 mmHg)and the CPAP non-responder group(<6.7 mmHg).The relationship between nocturnal short-term BPV and the antihypertensive effect of CPAP was analyzed.Results:There were 43 cases in the CPAP non-responder group,including 41 males and 2 females at a mean age of(42.0±9.5)years.There were 43 cases in the CPAP responder group,including 40 males and 3 females at a mean age of(39.6±7.9)years old.There were no significantly differences in sex distribution,age,BP in the outpatient,and nocturnal diastolic blood pressure(DBP)(all P>0.05).Compared with the CPAP non-responder group,the CPAP responder group exhibited more severe hypoxemia(mean SpO 2:89.0[87.0,91.0]%vs 93.0[90.0,93.0]%,Z=4.02,P<0.001;minimum SpO 2:63.0[57.0,69.0]%vs 73.0[65.0,80.0]%,Z=4.73,P<0.001)and higher nocturnal short-term BPV(ΔSBP:17.2[13.9,21.6]mmHg vs 9.4[7.9,15.0]mmHg,Z=4.

关 键 词：睡眠呼吸暂停 阻塞性 持续气道正压通气 高血压 降压效益 夜间短时血压变异性 

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