阻塞性睡眠呼吸暂停患者血管活性肠肽等与睡眠时血压变化的关系

The relationship of vasoactive intestinal peptide, other substances and the changes of nocturnal blood pressure in patients with obstructive sleep apnea syndrome

目的 明确清醒与不同睡眠期血管活性肠肽 (VIP)、一氧化氮 (NO)和内皮素 (ET)含量的差别及与阻塞性睡眠呼吸暂停综合征 (OSAS)患者夜间血压变化的关系。方法 12例OSAS患者在桡动脉内留置导管监测血压并同步进行夜间多导睡眠仪连续记录 ,分别于睡前清醒时、非快动眼睡眠(NREM)期、快动眼睡眠 (REM)期及清晨从桡动脉留置的导管内抽取血标本测定VIP、NO和ET。VIP和ET检测采用放射免疫分析法 ,NO检测采用硝酸还原酶法。结果 (1)OSAS患者清晨NO含量与睡前清醒时比较明显减少 (P =0 0 14) ;在清醒与不同睡眠期VIP及ET含量无明显变化 (P均 >0 0 5 ) ;(2 )OSAS患者清晨血中NO及ET含量与夜间低氧有关 ;清醒及不同睡眠期NO及ET含量与睡眠呼吸暂停指数 (AHI)无相关性 (P >0 0 5 ) ;(3)OSAS患者NREM睡眠期呼吸暂停前收缩压、舒张压的基础值(r=0 6 5 4,P <0 0 5 ;r =0 70 6 ,P <0 0 1)及REM睡眠期呼吸暂停前舒张压基础值 (r =0 6 13,P <0 0 5 )与VIP含量呈正相关 ;NO及ET含量与清醒及睡眠各期血压未发现明显相关性。结论OSAS患者清晨血中NO含量减少 ,可能存在血管内皮功能失常 ;

Objective To determine the difference of plasma VIP, NO and ET concentrations in awake and in different sleep periods and the relationship between VIP, NO and ET values and the changes in nocturnal blood pressure in patients with obstructive sleep apnea syndrome(OSAS) Methods Retaining manometric tube in radial artery and polysomnography(PSG) were done synchronously in 12 patients with OSAS whom was diagnosed by whole night PSG Blood specimens were collected before sleep, during NREM sleep and REM sleep and the next morning to detect the concentrations of VIP and ET by radioimmunoassay(RIA) and NO by nitrate reductase method Results (1) Plasma NO values were significantly decreased in the morning than those before sleep ( P =0 014) There was no remarkable changes of VIP and ET values in different testing periods (2) Plasma NO and ET values in the morning were correlated with hypoxia at night,but not with AHI ( P >0 05) (3)Plasma VIP values were significantly correlated with the baseline of SBP ( r =0 654, P <0 05) and DBP ( r =0 706, P <0 01) in NREM sleep and that of DBP ( r =0 613, P <0 05) in REM sleep There was no significant correlation between BP and plasma NO and ET values in different times Conclusions Endothelial dysfunction associated with NO reduction might be present and VIP might be involved in regulating BP changes in patients with OSAS