男性阻塞性睡眠呼吸暂停综合征对外周及中心血压影响的研究

Analysis for the Influence of Obstructive Sleep Apnea Syndrome on Peripheral and Central Blood Pressure in Male Patients

目的：探讨男性阻塞性睡眠呼吸暂停综合征（OSAS）对外周及中心血压的影响。方法：54例在我中心行睡眠呼吸暂停监测且未服用降压药物的男性患者，所有患者在行睡眠呼吸暂停监测前测量坐位外周血压、中心动脉压及肱踝脉搏波传导速度（ba-Pwv）。根据睡眠呼吸监测呼吸暂停低通气指数（AHI）将患者分为对照组20例（AHI〈5），OSAS组34例（AHI≥5）。两组间年龄、体重指数差异无统计学意义。结果：OSAS组中心动脉压、外周血压及ba-Pwv均较对照组显著增加（P〈0．05-0．01）。在OSAS患者中，中心收缩压与外周收缩压、外周舒张压和ba-Pwv均有较好的相关性（P〈0．05），ba-Pwv与年龄及外周收缩压有显著相关性（P〈0．05）。以中心收缩压为因变量，年龄、体重指数、呼吸暂停低通气指数、氧减指数、最低血氧饱和度、ha-PwV为自变量进行多元线性回归分析后，ba-PwV对中心收缩压的影响较大（P=0．014）。再以ba-PwV为因变量，呼吸暂停低通气指数、氧减指数、最低血氧饱和度、年龄、体重指数、外周收缩压和外周舒张压为自变量进行多元线性回归分析，氧减指数对ba-Pwv仍有较大影响（P=0．032）。结论：OSAS组患者外周血压、中心收缩压及动脉僵硬度高于对照组。中心收缩压升高可能与动脉僵硬度增加有关。

Objective： To analyze the influence of obstructive sleep apnea syndrome （OSAS） on peripheral and central blood pressure in male patients. Methods： There were 54 consecutive male patients for OSAS screening in our hospital were enrolled in this study, all patients without antihypertensive medication. Peripheral and central blood pressure, brachial-ankle pulse wave velocity （ba-PWV） were measured at sitting position before OSAS monitoring in all patients. According to apnea hypopnea index （AHI）, the patients were divided into 2 groups as Control group, AHI〈5, n=20, and OSAS group, AHI≥5, n=34. The age and body mass index （BMI） were similar between two groups. Results： Compared with Control group, OSAS group presented significantly increased central arterial pressure, peripheral blood pressure and ba-PWV, P〈0.05-0.01. In OSAS patients, the central systolic blood pressure （CSBP） and peripheral systolic blood pressure （PSBP） were closely related; peripheral diastolic blood pressure （PDBP） and ba-PWV were closely correlated, P〈0.05. Ba- PWV obviously related to age and PSBP, P〈0.05. Taking CSBP as response variable, the multiple regression analysis, including the age, BMI, AHI, oxygen desaturation index （ODI）, lowest SaO2 and ba-PWV revealed that ba-PWV was a significant contributor for increased CSBP in OSAS, P=O.014. In addition, taking ba-PWV as response variable, the multiple regression analysis, including AHI, ODI, lowest SaO2, age, BMI, PSBP and PDBP revealed that ODI was a significant contributor to affect ba-PWV, P=0.032. Conclusion： Peripheral blood pressure, CSBP and the arterial stiffness were all higher in OSAS patients. Elevated CSBP might be associated with the increased arterial stiffness.