睡眠呼吸暂停综合征与动态血压关系的研究

Relationship of Sleep Apnea Syndrome and Ambulatory Blood Pressure

目的 :探讨睡眠呼吸暂停综合征 (SAS)对 2 4h动态血压的影响。方法 :选择无心血管疾病的SAS患者和正常对照组各 30例进行多导睡眠图 (PSG)、2 4h动态血压 (ABPM )及血管活性物质一氧化氮 (NO)和内皮素 (ET)的监测。结果 :SAS患者ET、白天平均收缩压 (dMSP)高于正常对照 (P <0 0 5 ) ;呼吸紊乱指数(RDI)、最长呼吸暂停时间 (LAT)、夜间平均收缩压 (nMSP)、白天平均舒张压 (dMDP)、夜间平均舒张压(nMDP)、白天平均动脉压 (dMAP)、夜间平均动脉压 (nMAP)明显高于正常对照 (P <0 0 1) ;2 4h血压曲线呈非勺型 ;NO低于正常对照 (P <0 0 5 ) ;NO/ET、最低血氧饱和度 (LSaO2 )较正常对照明显降低 (P <0 0 1) ;SAS患者dMAP、nMAP与LSaO2 呈负相关 (Beta =- 0 5 6 1,P <0 0 5 ;Beta =- 0 388,P <0 0 5 ) ,RDI与nMAP呈显著正相关 (Beta =0 5 12 ,P <0 0 1)。结论 :SAS患者组各血压值均显著高于正常对照组 ,提示SAS可能是引起高血压的原因之一 ,其机制可能是由于反复缺氧 ,使血管功能失常 。

Objective:To explore the effect of sleep apnea syndrome(SAS) on ambulatory blood pressure (ABP)during 24 hours.Methods:30 SAS patients without cardiovascular complications and 30 normals were enrolled in study.The polysomnography (PSG) during sleeping and ABP during 24 hours were monitored.Vaso-active substances including nitric oxide(NO) and endothelin(ET) were measured.Results:The levels of ET and dMSP in patients with SAS were higher than those in control group(P<0.05).The levels of RDI、LAT、nMSP、dMDP、nMDP、dMAP and nMAP in patients with SAS were significantly higher than those in control group(P<0.01).The level of NO in patients with SAS was lower than that in control group (P<0.05).The levels of NO/ET and LSaO 2 in patients with SAS were significantly lower than in control group(P<0.01).In SAS group,dMAP and nMAP were negatively correlated with LSaO 2 (Beta=-0.561,P<0.05;Beta= -0.388,P<0.05),nMAP positively correlated with RDI (Beta= 0.512,P<0.01).Conclusion:The blood pressures in SAS group is higher than those in control group,which indicates that SAS may be one of the causes involving in hypertension.Abrrormal vascular function caused by repeated hypoxia accounts for the decreasing of NO and increasing of ET.