阻塞性睡眠呼吸暂停综合征合并高血压患者血压昼夜节律的研究

The study of circadicon blood pressure variability in the patients with hypertension and obstructive sleep apnea

目的 研究阻塞性睡眠呼吸暂停综合征对高血压患者血压昼夜节律的影响。方法 184例研究对象根据诊所血压、2 4小时动态血压和多导睡眠图监测结果分为正常对照组、高血压组、轻度以及中重度睡眠呼吸暂停合并高血压组。比较睡眠呼吸暂停指数、睡眠结构对血压昼夜节律的影响。结果 中重度睡眠呼吸暂停合并高血压患者中 ,6 9.4 %的昼夜血压曲线呈非勺 (non -dipper)型 ,其发生频率较其他各组显著增高 ,均有统计学显著性意义 (P <0 .0 0 1) ;Ⅲ -Ⅳ期非快速动眼睡眠 (NREM)和快速动眼睡眠 (REM)时间占总睡眠时间的比率 (为 9.93%和12 .5 6 % )显著低于其他各组 ,AHI与Ⅲ -Ⅳ期和REM期呈负相关 (r=- 0 .2 99,P <0 .0 1和r=- 0 .2 2 9,P <0 .0 5 )。结论 血压昼夜节律与睡眠结构破坏和呼吸暂停严重程度显著相关 ,non -dipper型血压曲线增加可能是睡眠呼吸暂停组患者心血管事件增加的重要危险因素。

Objective The influence on circadian blood pressure variability in the hypertensive patients with or without obstructive sleep apnea.Methods One hundred and eighty-four subjects were divided into health control group,hypertensive group, hypertension with mild obstructive sleep apnea (OSA) group,hypertension with moderate and severe OSA group by the results of clinical blood pressure measurement, 24-h ambulatory blood pressure morning (ABP) and polysomnography (PSG).Results In the hypertension with moderate and severe OSA group, 69.4% patients' blood pressure presented non-dipper profile. The frequency of non-dipper blood pressure profile in the group was significantly higher than other groups (P<0.001). The sleep structure was significantly different in the hypertension with moderate and severe OSA group from other groups. The percentage of Ⅲ and IV sleep phases was only 9.93% in non rapid eye movement (NREM) sleep stage and the percentage of the rapid eye movement (REM) stage was only 12.56% in the whole sleep stages. The apnea-hypopnea index (AHI) was negative correlated to the proportion of Ⅲ and IV sleep phases and REM sleep stage (r=-0.299,P<0.01 and r=-0.229,P<0.05).Conclusion The circadian blood pressure variability was significantly related to the OSA severity, and the non-dipper blood pressure profile was one of potential risk factors to cardiovascular events in the patients with OSA.