高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

Circadian Blood Pressure in Hypertensive Patients with Obstructive Sleep Apnea Syndrome Before and After Treatment

目的探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化。方法入选高血压患者105例,根据多导睡眠仪监测结果分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组36例和高血压合并中、重度 OSAS 组22例。CPAP 或手术治疗前后行24 h 动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系。结果治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%。与单纯高血压组比较,差异有统计学意义(P<0.05)。治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%,38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05)。中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显。结论高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与 OSAS 严重性相关,CPAP 或手术治疗后非杓型明显减少。

Objective To explore the circadian blood pressure variability in hypertensive patients with obstructive sleep apnea syndrome （OSAS） before and after continuos positive air way pressure（CPAP）or surgical treatment. Methods One hundred and five hypertensive patients were enrolled, which were classified into three groups dependent on the finding of polysomnography （PSG） ： hypertensive without OSAS（n = 47）, hypertensive with mild OSAS（n 36） and hypertensive with moderate-severe OSAS（n= 22）. All patients were monitored with 24-hour ambulatory blood pressure monitoring （ABPM）before and after treatment. Results Before treatment Non-dipper 23.4% in the hypertensive without OSAS group was delineated as non-dipper type, while 47.2% and 59.1% was found in hypertensive with mild OSAS and with moderate-severe OSAS patients, non-dipper type lowering the latter 2 group of patients was obviously higher than that of hypertensive without OSAS group. After treatment non-dipper type decrease to 19.1%, 38.9% and 45.5% in 3 groups respectively. Most remarkable effect was shown in moderate-severe OSAS patients. Conclusion Partial obstruction of air way should always be considered in the hypertensive patients with non-dipper type. Circadian blood pressure variability is correlated to the severity of OSAS, which can be alleviated after treatment.