高血压合并阻塞性睡眠呼吸暂停低通气综合征患者血压水平及血压变异性分析

摘要

Objective To explore blood pressure level and variability in patients with hypertension and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods One hundred and twenty-six patients with hypertension were enrolled and divided into four groups ( group 1, without OSAHS; group 2, with mild OSAHS; group 3, with moderate OSAHS and group 4, with severe OSAHS). Blood pressure and its variability were compared among the four groups,and one way ANOVA and multiple linear regression were used for statistical analysis. Results The mean blood pressure at daytime and night were significantly greater in group 4 ( 144. 7/100. 3 ± 12. 5/10. 0 mm Hg and 136. 5/91. 1 ± 13. 3/9. 5 mmHg) than in group 1 ( 131. 2/92. 4 ± 15. 6/8. 6 mm Hg, 124. 9/84. 7 ± 18. 3/11. 7 mm Hg, bothP<0.05). There was no significant difference of blood pressure between mild and moderate OSAHS group. The variability of daytime blood pressure was significantly greater in group 4 ( 13. 0/10. 5 ± 3. 0/2. 0 mm Hg) than in group 1 (11. 3/9. 3 ± 3. 2/1. 8 mm Hg). The variability of night blood pressure was significantly greater in group 4 (12. 6/12. 4 ±4. 2/4. 2 mm Hg) than in group 1 (12. 1/9.9 ±2.8/2. 3 mmHg) , group 2 (11. 3/10. 0 ±2. 8/3. 0 mmHg) and group 3 (11.9/9. 4 ±3.6/2.5 mm Hg, both P < 0. 05). Multiple regression analysis showed that min SaO2 was an important factor affecting night and daytime blood pressure variability ( B = - 0. 103 , P < 0. 001; B = - 0. 086, P < 0. 003 ). Conclusions Severe OSAHS is positively correlated with hypertension and increases the variability of blood pressure. Hypoxia is an important factor for increasing the blood pressure variability in OSAHS patients.%目的 探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压水平和血压变异性特点.方法 选择在我院高血压科诊治的126例高血压患者,经多导睡眠呼吸监测仪监测,分为4组:单纯高血压组34例,高血压合并轻度OSAHS组35例,高血压合并中度OSAHS组25例,高血压合并重度OSAHS组32例.对研究资料行单因素方差分析和多元线性回归分析,比较4组患者日间、夜间平均血压和血压变异,探讨夜间血压变异的影响因素.结果 高血压合并重度OSAHS组日间、夜间平均血压(144.7/100.3±12.5/10.0 mm Hg,136.5/91.1±13.3/9.5 mm Hg)较单纯高血压组(131.2/92.4±15.6/8.6 mm Hg,124.9/84.7±18.3/11.7 mm Hg)明显升高(P＜0.05),而高血压合并轻、中度OSAHS组与单纯高血压组的日间血压、夜间血压比较差异无统计学意义(均为P＞0.05).高血压合并重度OSAHS组患者日间血压变异性(13.0/10.5±3.0/2.0 mm Hg)较单纯高血压组(11.3/9.3±3.2/1.8 mm Hg)明显增加(P＜0.05),高血压合并重度OSAHS组夜间血压变异性(12.6/12.4±4.2/4.2 mm Hg)与单纯高血压组(12.1/9.9±2.8/2.3 mm Hg)、高血压合并轻度OSAHS组(11.3/10.0±2.8/3.0 mm Hg)、高血压合并中度OSAHS组(11.9/9.4±3.6/2.5 mm Hg)比较均显著增加(均为P＜0.05).多元线性回归分析显示,夜间最低血氧饱和度是影响OSAHS患者夜间收缩压变异和舒张压变异的重要因素(B=-0.103,P＜0.00;B=-0.086,P＜0.003).结论 高血压患者如合并重度OSAHS,全天血压水平均明显增高,血压变异性明显增加,夜间缺氧是高血压合并OSAHS患者夜间血压变异性增加的重要原因.