高血压合并阻塞性睡眠呼吸暂停综合征患者昼夜血压的变化

Changes of circadian blood pressure in patients with hypertension and obstructive sleep apnea syndrome

目的研究轻中度高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者昼夜血压变化的特点。方法入选心功能(NHYA)Ⅰ级的轻中度高血压患者177例,经多导睡眠呼吸监测后,按睡眠呼吸暂停指数分为4组,单纯高血压组(A组)42例,高血压合并轻度OSAS组(B组)66例,高血压合并中度OSAS组(C组)25例和高血压合并重度OSAS组(D组)44例,进行24 h动态血压监测。结果 D组患者昼间和夜间血压水平明显高于A组(P<0.05,P<0.01),与A组比较,B、C和D组夜间舒张压显著升高(P<0.05,P<0.01)。夜间低血氧水平与醒时、醒后舒张压、昼间、夜间收缩压和舒张压呈负相关(P<0.05)。结论轻中度高血压合并OSAS患者的夜间舒张压更高,合并重度OSAS的高血压患者全天血压水平均明显高于单纯高血压患者,血压升高幅度与夜间低氧血症程度呈负相关。

Objective To analyze the characteristics of 24-hour ambulatory blood pressure（ABP） in mild or moderate hypertensive patients with obstructive sleep apnea syndrome（OSAS）. Methods 177 hypertensive patients with cardiac function class I received polysomnography and ABP monitoring. They were divided into hypertension（EH） group,EH combined with mild OSAS group, EH combined with moderate OSAS group and EH combined with severe OSAS group according to the monitoring results. The average systolic and diatolic blood pressure in daytime and nighttime among the four groups were compared. Results The 24-hour average systolic and diastolic pressures were significantly higher in the EH combined with severe OSAS group than in the EH group （P〈 0.05）. The night average diastolic pressure was significantly higher in three EH combined with OSAS groups than in the EH group （P 〈 0.05）. There was a negative correlation between the night hypoxemia and the level of blood pressure （P〈 0.05）. Conclusion In the patients with mild or moderate： hypertension, the level of 24 hour blood pressure was significantly higher in severe OSAS group than in the EH group. There was a negative correlation between the severity of hypoxemia of the OSAS patients and the level of blood pressure.