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

摘要

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.%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3607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≥30,1842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。