不同睡眠期阻塞性睡眠呼吸暂停患者的夜间血压变化及影响因素研究  

Analysis of nocturnal blood pressure changes and influencing factors in patients with obstructive sleep apnea during different sleep periods

作　　者：舒茂莎 张晓晴[1,2] Shu Maosha;Zhang Xiaoqing(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041;Dept of Otorhinolaryngology,West China Fourth Hospital,Chengdu 610041)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院,成都610041 [2]华西第四医院耳鼻喉科睡眠呼吸疾病诊治中心,成都610041

出　　处：《安徽医科大学学报》2025年第3期502-506,共5页Acta Universitatis Medicinalis Anhui

基　　金：四川省科技计划项目(编号:2021YFH0165)。

摘　　要：目的 观察阻塞性睡眠呼吸暂停(OSA)患者快速眼动(REM)、非快速眼动(NREM)睡眠期血压变化的特征,分析不同睡眠期阻塞性呼吸事件对血压的影响。方法 采用横断面研究的方法,选取确诊为OSA的患者1 219例,对患者REM、NREM睡眠期的阻塞性呼吸事件和血压进行监测,分析OSA患者在不同睡眠期血压波动的特点以及阻塞性呼吸事件对血压波动的影响。结果 随着OSA病情的加重,患者不同睡眠期的SBP、DBP均呈现上升趋势。SBP、DBP、平均呼吸暂停时间(MAT)、平均低通气时间(MHT)、最低血氧饱和度(LSpO_(2))、氧减指数(ODI)指标在不同睡眠期的差异有统计学意义(P<0.05)。经多元线性回归分析,REM睡眠期的SBP与LSpO_(2)、呼吸暂停低通气指数(AHI)呈负相关(P<0.05),与ODI呈正相关(P<0.05);DBP与LSpO_(2)、AHI、MHT呈负相关(P<0.05),与ODI呈正相关(P<0.05)。NREM睡眠期的SBP、DBP与LSpO_(2)呈负相关(P<0.05)。结论 随OSA病情的加重,患者不同睡眠期的血压值随之升高,OSA患者REM睡眠期的血压水平高于NREM睡眠期,LSpO_(2)与患者不同睡眠期间的血压变化密切相关,AHI、ODI、MHT与患者REM睡眠期的血压变化密切相关。Objective To monitor changes in blood pressure during rapid eye movement(REM)and non-REM(NREM)sleep in patients with obstructive sleep apnea(OSA),and to analyze the effect of obstructive respiratory events on blood pressure during different sleep stages.Methods A cross-sectional trial was adopted on 1219 patients diagnosed with OSA.The obstructive respiratory events and blood pressure of patients during REM and NREM sleep were monitored.Additionally,the symptoms of blood pressure fluctuations in OSA patients during different sleep periods and the effects of obstructive respiratory events on blood pressure fluctuations were analyzed.Results SBP and DBP during REM and NREM sleep both tended to rise as OSA worsened.The differences in SBP,DBP,mean apnea time(MAT),mean hypoventilation time(MHT),lowest oxygen saturation(LSpO_(2)),and oxygen desaturation index(ODI)in different sleep periods were statistically significant(P<0.05).Multiple linear regression analysis revealed that SBP during REM sleep was negatively correlated with LSpO_(2) and the apnea-hypopnea index(AHI)(P<0.05),but positively correlated with ODI(P<0.05).DBP during REM sleep was negatively correlated with LSpO_(2),AHI,and MHT(P<0.05),but positively correlated with ODI(P<0.05);SBP and DBP during NREM sleep were negatively correlated with LSpO_(2)(P<0.05).Conclusion As the severity of OSA increases,the blood pressure values during different sleep periods rise accordingly.The blood pressure levels during REM sleep in OSA patients are higher than those during NREM sleep.LSpO_(2) is an important factor causing blood pressure changes in different sleep periods.AHI,ODI,and MHT are important factors causing blood pressure changes during REM sleep.

关 键 词：REM OSA non-REM OSA 高血压 平均低通气时间 最低血氧饱和度 氧减指数 

分 类 号：R766[医药卫生—耳鼻咽喉科]