老年高血压合并阻塞性睡眠呼吸暂停综合征患者血压昼夜节律的特点

Clinical study on the circadian rhythm of blood pressure in elderly hypertensive patients with obstructive sleep apnea syndrome

目的探讨老年高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者血压昼夜节律的特点。方法入选老年原发性高血压患者90例,根据多导睡眠监测结果,将受试者分为单纯高血压组(42例)、高血压合并轻度OSAS组(21例)、高血压合并中、重度OSAS组(27例),行24 h动态血压监测,观察睡眠呼吸状态对血压昼夜节律的影响。结果高血压合并轻度OSAS组、高血压合并中、重度OSAS组与单纯高血压组比较,夜间收缩压、舒张压差异有显著性意义(P<0.05);与单纯高血压组比较,高血压合并轻度OSAS组血压曲线非杓型所占比例差异有显著性意义(P<0.05),高血压合并中、重度OSAS组比例有显著性差异(P<0.01);高血压合并中、重度OSAS组与高血压合并轻度OSAS组比较血压非杓型所占比例差异有显著性意义(P<0.05)。结论老年高血压合并OSAS患者其血压变异高于单纯高血压患者,这在合并有中、重度OSAS的患者表现尤其明显,因此老年高血压患者要注意睡眠状态时血压的变化,早期诊断OSAS并积极有效地治疗。

Objectives To investigate the influence of obstructive sleep apnea syndrome（OSAS） on blood pressure variability in elderly patients with hypertension. Methods Ninety elderly hypertensive patients were enrolled and divided into three groups based on polysomnography（PSG,hypertension group 42 persons; hypertension with mild OSAS 21 persons; hypertension with moderate-severe OSAS 27 persons）. All patients received the 24-hour blood pressure monitoring. Results Compared with hypertension group,there was significant difference in nocturnal SBP and DBP in hypertension with mild OSAS group and hypertension with moderate-severe OSAS group（ P〈0.05）. There were differences in the proportion of non-dipper profile of blood pressure curve between three groups（ P〈0.05）. Conclusions There is a link between circadian rhythm of blood pressure and OSAS severity. It is important to monitor blood pressure under sleep condition for elderly hypertensive patients,and OSAS should be diagnosed early and treated actively.