高血压合并阻塞性睡眠呼吸暂停综合征动态血压临床分析

摘要

目的:探讨高血压合并阻塞性睡眠呼吸暂停综合征动态血压的临床特点.方法:高血压合并阻塞性睡眠呼吸暂停综合征患者作为睡眠呼吸暂停组,单纯高血压患者作为高血压组,所入选的88例患者均行24h动态血压监测,比较两组患者24h动态血压的特点.结果:(1)睡眠呼吸暂停组较高血压组体重指数(BMI)和颈围及血清TC、TG和LDL-C明显增加,而HDL-C明显降低(P<0.01).(2)睡眠呼吸暂停组较高血压组呼吸暂停低通气次数及累计时间、低血氧事件次数及累计时间均明显增加(P<0.01).(3)睡眠呼吸暂停组较高血压组夜间平均收缩压(nSBP)和夜间平均舒张压(nDBP)及24小时平均收缩压标准差(24hSBPSD)、日间平均收缩压标准差(dSBPSD)和日间平均收缩压变异系数(dSBPCV)、日间平均舒张压标准差(dDBPSD)、夜间均收缩压标准差(nSBPSD)和夜间平均收缩压变异系数(nSBPCV)明显升高;收缩压(SBP)和舒张压(DBP)昼夜节律消失比例明显增加(P<0.05).结论:高血压合并阻塞性睡眠呼吸暂停综合征患者存在夜间平均收缩压和夜间平均舒张压升高,非杓型血压比例增加,同时血压变异性的增加,均加重对动脉血管损害.%Objective: To investigate the clinical characteristics of ambulatory blood pressure monitoring (ABPM) in hypertension patients with obstructive sleep apnea syndrome (OSAS).Methods:A total of 88 patients were enrolled, of which 42 hypertension patients with OSAS were assigned to OSAS group and 46 hypertension patients without OSAS were assigned to hypertension group. The change of blood pressure was determined by 24-hour ambulatory blood pressure monitoring and the characteristics of ambulatory blood pressures between the 2 groups were compared. Results:(1) Body mass index (BMI), neck circumference, total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol(LDL-C) were higher, while high density lipoprotein cholesterol(HDL-C)was lower in OSAS group (P＜0. 01). (2) Apnea-hypopnea index (AHI)events and total events duration,hypopnea events and total events duration were higher in OSAS group (P＜0.01). (3) nSBP (night systolic blood pressure), nDBP (night diastolic blood pressure), 24h SBPSD (24-hour systolic blood pressure standard deviation), dSBPSD(day systolic blood pressure standard deviation), dSBPCV (day systolic blood pressure coefficient of variation), dDBPSD(day diastolic blood pressure standard deviation), nSBPSD(night systolic blood pressure standard deviation), nSBPCV(night systolic blood pressure coefficient of variation)and the loss percentage of day-to-night rhythm of SBP(systolic blood pressure) and DBP (diastolic blood pressure)were higher in OSAS group (P＜ 0.05). Conclusion:Hypertension patients with OSAS are characterized by the nocturnal rise of the average systolic blood pressure and the average diastolic blood pressure, contributing to the higher percentage of non-dipped and the rise of blood pressure variability,which does obviously more harm to artery.