高血压合并睡眠呼吸暂停综合征患者血压节律及心率变异

Circadian rhythm and heart rate variability in hypertensive patients complicated with obstructive sleep apnea syndrome

目的研究阻塞性睡眠呼吸暂停（OSAS）对高血压病患者血压昼夜节律及心率变异（HRV）的影响。方法选取2007年4月至2010年4月中国人民解放军总参谋部警卫局保健处和北京军区总医院心血管内科住院的91例患者，根据患者是否患有高血压病及OSAS分为对照组、单纯高血压组和高血压病合并OSAS组。比较3组之间非勺型昼夜血压曲线的比例、HRV时域指标与频域指标、夜间平均血氧水平以及呼吸紊乱指数（AHI）的差异。结果高血压病合并OSAS组患者呈非勺型昼夜血压曲线的比例以及HRV时域指标值与频域指标值较其他两组明显增加（P〈0．01），并且夜间平均血氧水平显著低于其他两组，而AHI则明显高于其他两组（P〈0．01）。结论OSAS导致高血压病患者血压昼夜节律呈非勺型、HRV增强、夜间平均血氧水平下降、AHI明显增加，是高血压病患者心血管事件增加的重要危险因素。

Objective To investigate the influence of obstructive sleep apnea （OSAS） on circadian blood pressure variability and heart rate variability （HRV） in essential hypertensive patients. Methods A total of 91 patients admitted in our hospital were divided into three groups, according to the patients suffered from hypertension or/and OSAS, including normal group, pure hypertension group and hypertension complicated with OSAS group （complication group）. The rate of non-dipper day-night blood pressure curve, time-domain indexes, frequency-domain indexes, average night blood oxygen level, apnea-hypopnea index （AHI） were compared among three groups. Results Compared with other groups, the rate of non-dipper day-night blood pressure curve, time-domain indexes, frequency-domain indexes, AHI were obviously higher in complication group （P 〈 0.01）, and average night blood oxygen level were obviously lower in complication group （P 〈 0.01）. Conclusion OSAS could make non-dipper day-night blood pressure curve, enhance HRV, descend average night blood oxygen level, and increase AHI, indicating that OSAS is an important risk factor to adverse cardiac events of essential hypertensive patients.