高血压合并OSAHS患者睡眠期间收缩压水平变化临床意义

Clinical significande of systolic pressure level during sleep in hypertensive patients with OSAHS

目的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与高血压之间存在密切相关性,但目前针对OSAHS患者血压波动尤其是收缩压变化与高血压相关性的研究较少。本研究探讨高血压合并OSAHS患者睡眠期间收缩压变化的临床意义。方法选择2018-03-31-2019-04-30濮阳市油田总医院收治的初治高血压患者80例作为研究对象,其中合并OSAHS患者40例为病例组,单纯高血压患者40例为对照组。统计整个睡眠过程中两组出现的自发性血压升高、呼吸相关性血压升高、睡眠期血压升高及觉醒期血压升高比例,并分析睡眠前30min、快动眼睡眠时期、慢动眼睡眠时期、苏醒前30min,两组收缩压变化情况,计算两组呼吸暂停指数及阻塞性指数。结果病例组出现自发性血压升高(χ^2=19.835,P<0.001)、呼吸相关性血压升高(χ^2=36.565,P<0.001)、睡眠期血压升高(χ^2=25.128,P<0.001)及觉醒期血压升高(χ^2=30.336,P<0.001)比例均大于对照组,差异有统计学意义。病例组快动眼睡眠时期、慢动眼睡眠时期和苏醒前30min收缩压水平分别为(133.8±2.3)、(128.6±2.1)和(135.5±3.2)mm Hg,均高于对照组的(143.3±2.5)、(142.3±1.8)和(149.2±3.4)mm Hg,t值分别为17.687,31.327和18.558,均P<0.001。病例组呼吸暂停指数和阻塞性指数分别为(43.2±2.6)和(15.2±1.6)mm Hg,均高于对照组的(13.5±1.2)和(8.6±0.8)mm Hg,t值分别为65.596和23.335,均P<0.001。结论高血压合并OSAHS患者,睡眠过程中收缩压升高明显,且血压增高水平与OSAHS病情严重程度存在一定关联。

OBJECTIVE There is a close relationship between obstructive sleep apnea hypopnea syndrome(OSAHS)and hypertension.However,there are few reports on the relationship between blood pressure fluctuation,especially systolic blood pressure change and hypertension in patients with OSAHS.The purpose of this study was to investigate the clinical significance of systolic blood pressure changes during sleep in patients with hypertension and OSAHS.METHODS A total of 80 cases with primary hypertension admitted in Puyang Oilfield General Hospital from March 31,2018 to April 30,2019 were selected,including 40 patients with OSAHS and 40 patients with simple hypertension.Then the spontaneous blood pressure rise,respiratory-related blood pressure rise,sleep phase blood pressure rise and awakening phase blood pressure rise ratio in the two groups during the whole sleep process were counted,and the changes of systolic blood pressure in the two groups were analyzed,and the apnea index and obstructive index in the two groups were calculated 30 min before sleep,rapid eye movement sleep phase,slow eye movement sleep phase and 30 min before waking.RESULTS The proportions of spontaneous blood pressure rise(χ^2=19.835,P<0.001),respiratory-related blood pressure rise(χ^2=36.565,P<0.001),sleep blood pressure rise(χ^2=25.128,P<0.001)and awakening blood pressure rise(χ^2=30.336,P<0.001)in the case group were higher than those in the control group.The rapid eye movement sleep period,slow eye movement sleep period and 30 min before awakening in the case group were(133.8±2.3),(128.6±2.1)and(135.5±3.2)mm Hg,which were significantly higher than those in the control group(143.3±2.5),(142.3±1.8)and(149.2±3.4)mmHg,t values were 17.687,31.327 and 18.558,all P<0.001.The apnea index and obstructive index of the case group were(43.2±2.6)and(15.2±1.6),which were higher than those of the control group(13.5±1.2)and(8.6±0.8),t values were65.596 and 23.335,both P<0.001.CONCLUSION In patients with hypertension complicated with OSAHS,systolic blood pressure increases significantly during sleep,There is a certain correlation with between the increased blood pressure level and the severity with obstructive sleep apnea hypopnea syndrome.