高血压合并阻塞性睡眠呼吸暂停患者的血压变异性

Blood pressure variability in the patients with hypertension and obstructive sleep apnea-hypopnea syndrome

目的探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血压变异性特点。方法纳入疑似OSAHS的高血压患者217例,根据睡眠呼吸暂停低通气指数(AHI)分为4组:非OSAHS组(33例),轻度OSAHS组(57例),中度OSAHS组(68例),重度OSAHS组(59例),比较各组患者血生化指标、血压及血压变异性,分析AHI与血压变异性的关系。结果 4组患者的体质量指数(BMI)和血压变异性明显不同,随睡眠呼吸暂停的严重程度增加而增大(P<0.05)。以BMI进行分层后,超重及肥胖高血压患者的夜间血压变异性随睡眠呼吸暂停严重程度的增加而增大(P<0.05)。偏相关分析显示控制年龄、BMI、血压后,AHI与24h收缩压变异性、24h舒张压变异性、白昼收缩压变异性、白昼舒张压变异性、夜间收缩压变异性及夜间舒张压变异性呈正相关(分别r=0.346,0.414,0.263,0.324,0.445,0.570,均P<0.05)。结论 AHI与血压变异性相关,睡眠呼吸暂停对夜间血压变异性影响更为明显。

Objective To explore the characteristics of blood pressure variability in the patients with hypertension and obstructive sleep apnea-hypopnea syndrome（OSAHS）.Methods A total of 217 hypertensive patients with suspected OSAHS were enrolled and divided into four groups according to apnea-hypopnea index（AHI）：non-OSAHS group（n=33）,mild OSAHS group（n=57）,moderate OSAHS group（n=68） and severe OSAHS group（n=59）.Blood biochemical parameters,blood pressure and blood pressure variability were compared.The relationship between AHI and blood pressure variability was analyzed.Results A progressive increase in blood pressure variability was observed as sleep apnea increased in severity from mild levels to moderate to severe levels（P0.05）.In overweight and obese patients stratified by BMI,the nighttime blood pressure variability increased with the increasing AHI（P0.05）.After controlling age,BMI and blood pressure,partial correlation analysis showed that AHI was positively correlated with 24-hour systolic blood pressure variability,24-hour diastolic blood pressure variability,daytime systolic blood pressure variability,daytime diastolic blood pressure variability,nighttime systolic blood pressure variability and nighttime diastolic blood pressure variability（r=0.346,0.414,0.263,0.324,0.445,0.570,P0.05）.Conclusion AHI was significantly related to the blood pressure variability,especially nighttime blood pressure variability.