天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (10): 1147-1151.doi: 10.11958/j.issn.0253-9896.2015.10.017

• 临床研究 • 上一篇    下一篇

阻塞性睡眠呼吸暂停患者的高血压患病情况及其与呼吸功能的关系

  

  1. 1山东中医药大学第二附属医院职业病科 （邮编 250001）； 2天津医科大学总医院呼吸科
  • 收稿日期:2015-06-05 修回日期:2015-07-06 出版日期:2015-10-15 发布日期:2015-10-22

The prevalence of hypertension in patients with obstructive sleep apnea hypopnea#br# syndrome and their relationship

  1. 1 Department of Occupational Disease, The Second Affiliated Hospital of Shandong University of Traditional Chinese
    Medicine, Jinan 250001, China; 2 Department of Respiratory Medicine, General Hospital of Tianjin Medical University
  • Received:2015-06-05 Revised:2015-07-06 Published:2015-10-15 Online:2015-10-22

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摘要：

摘要： 目的 分析阻塞性睡眠呼吸暂停(OSA)患者的高血压患病率， 并分析其血压与呼吸通气功能指标的关系。
方法 选取 3 607 例 OSA 患者， 根据呼吸暂停低通气指数 （AHI） 将患者分为 4 组： 对照组 （AHI<5,354 例）、 OSA 轻度
组 （5≤AHI<15,658 例）、 中度组 （15≤AHI<30,753 例）、 重度组 （AHI ≥30,1 842 例）。测量入组患者 4 个时间点 （日间、
睡前、 夜间、 晨起）的血压值， 计算夜间与日间平均血压比值(RN/D)、 晨起与睡前平均血压比值(RM/E)。比较 4 组的一般
指标、 高血压患病率、 4 个时间点的平均血压（MBP）值等， 分析 MBP 与 AHI、 最低血氧饱和度（LSaO2）的相关性。结
果 OSA 轻 （34.65%）、 中 （39.04%）、 重度组 （55.37%） 的高血压患病率均高于对照组 （22.32%）， 重度组的高血压患病
率高于轻、 中度组(均 P < 0.05)。对于日间及睡前 MBP， OSA 轻、 中、 重度组均高于对照组， OSA 重度组高于轻、 中度
组； 对于夜间及晨起 MBP， 重度组＞中度组＞轻度组＞对照组（均 P＜0.05）。日间、 睡前、 夜间、 晨起的 MBP 值均随
AHI 增加而升高。RN/D及 RM/E均随疾病严重度增加而升高。日间血压与 AHI、 LSaO2显著相关(收缩压, r 分别为 0.195
和-0.206； 舒张压， r 分别为 0.248 和-0.251, P < 0.01)。随着 AHI 的增加， 日间 MBP 值逐渐增高； 当 AHI 达到 61~65
区间之后， 日间 MBP 值通常不再增高或略有降低。结论 OSA 患者夜间和晨起血压明显升高， 失去正常的昼夜节
律。OSA 是高血压的独立危险因素。

关键词: 睡眠呼吸暂停, 阻塞性, 高血压, 血压, 昼夜模式, 低通气指数, 最低血氧饱和度

Abstract:

Abstract： Objective To investigate the prevalence of hypertension in patients with obstructive sleep apnea hypopnea
syndrome (OSA) and the relationship between blood pressure (BP) with respiratory ventilation function. Methods Patients
with OSA (n=3 607) were included in this study and divided into 4 groups based on their apnea- hypopnea index (AHI)
scores: control group (control, n=354) with AHI<5; mild OSAHS (mild, n=658) with 5≤AHI<15; moderate OSAHS (moder⁃
ate, n=753) with 15≤AHI<30; and severe OSA (severe, n=1 842) with AHI≥30. BP were measured at 4 time points (daytime,
evening, midnight, and morning). The midnight / daytime average BP (RN/D) and morning/evening average BP (RM/E) ratios
were calculated. Finally, the general profiles, prevalence of hypertension and average BP of 4 time points were compared
among 4 groups. The correlations of MBP with AHI and LSaO2 were also analyzed. Results The prevalence of hypertension
as well as MBP at daytime and in the morning in the mild group (34.65% ), moderate group (39.04% ) and severe group
(55.37%) were all higher than that in control group (22.32%)(all P < 0.05). The prevalence of hypertension as well as MBP at
daytime and in the morning were both higher in severe group than those in mild and moderate groups. MPB in the evening
and at midnight was higher in severe group than that in moderate group than that in mild group than in control group (P <
0.05). Average MBP of all four time points rise with increasing AHI (all P < 0.05). The ratios of nighttime to daytime MBP
(RN/D) and of morning to evening MBP (RM/E) increased with the severity of the illness (F=9.821, 18.957; P < 0.001). The day⁃time BP correlated well with AHI and lowest oxygen saturation (LSaO2; systolic BP, r=0.195, -0.206; diastolic BP, r=0.248, -
0.251, P < 0.01). Daytime MBP increased gradually with increasing AHI until MPB reached 61-65, at which point it either
plateaued or dropped slightly. Conclusion OSA patients have a significant increase in midnight and morning BP and
lose normal BP nycterohemeral rhythm. OSA is an independent risk factor for hypertension.

Key words: sleep apnea, obstructive, hypertension, blood pressure, circadian variation, AHI, LSaO2