睡眠呼吸暂停综合征与晨峰血压、心率关系的研究

Relationship of sleep apnea syndrome to morning blood pressure surge and heart rate variability

目的探讨睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)与晨峰血压、心率变异性的关系。方法对64例检查明确为OSAS,且合并原发性高血压的患者行24 h动态血压监测和动态心电图监测,按OSAS合并高血压患者是否合并血压晨峰分为两组:OSAS合并高血压病伴血压晨峰组(晨峰组)33例,OSAS合并高血压病不伴血压晨峰组(非晨峰组)31例,以及同期健康体检人员30例作为对照组,比较3组睡眠呼吸监测结果及血压昼夜节律变化和心率变异性结果。结果晨峰组及非晨峰组和对照组比较,呼吸紊乱指数(AHI)增高(P<0.01),最低血氧饱和度降低(P<0.01),血压昼夜节律均有明显改变(P<0.01);晨峰组和非晨峰组比较,AHI、最低血氧饱和度和血压昼夜节律也有所不同,晨峰组AHI更高(P<0.05),最低血氧饱和度更低(P<0.05),非杓型血压昼夜节律者明显增多(P<0.05)。关于心率变异性,晨峰组及非晨峰组和对照组相比,低频谱、LF/HF增高(P<0.05),高频谱、SDNN、PNN50、HRVI降低(P<0.05),晨峰组和非晨峰组的HRVI相比也有显著性差异(P<0.05),其它指标在数值上也有差异,但差异没有统计学意义(P>0.05)。结论 OSAS合并高血压病伴血压晨峰AHI更高,最低血氧饱和度更低,非杓型血压昼夜节律者明显增多,自主神经损伤程度更严重,更容易发生心脑血管不良事件。

Objective To investigate the relationship of sleep apnea syndrome to morning blood pressure surge and heart rate variability. Methods Sixty-four patients with obstructive sleep apnea syndrome （OSAS） and essential hypertention underwent 24-hour ambulatory blood pressure monitoring （ABPM） and 24-hour Holter. According to ABPM, they were divided into two groups： the morning blood pressure surge group （MBPS group） included 33 patients and the non-MBPS group with 31. In addition, the control guoup consisted of 30 healthy persons at the same time. The parameters in sleep-breathing monitoring, circadian rhythm of blood pressureand heart rate variability among the three groups were compared. Results Patients in MBPS group and non-MBPS group had higher apnea hypopnea index （ AHI, P 〈 O. O1 ） , lower mini- mum blood oxygen saturation level （ P 〈 0. O1 ） and considerably different circadian rhythm of blood pressure compared with the control guoup. Patients in MBPS group had much higher AHI （ P 〈 O. 05 ） and further lower minimum blood oxygen saturation level （ P 〈 O. 05 ） , and includ- ed more patients with non-dipper hypertention compared to non-MBPS group （ P 〈 O. 05 ）. Re- garding heart rate variability, low-frequency （ LF ） , LF/HF were higher （ P 〈 O. 05 ）, while high-frequency （HF） , SDNN, PNN50, HRVI were lower（P 〈 O. 05）. Moreover, other pa- rameters in these two groups were also different in numerus but not in statistics （ P 〉 O. 05 ）. Conclusion Patients with MBPS have higher AHI and lower minimum blood oxygen saturation level, comprise more patients with non-dipper hypertention, suffer from more serious damage to autonomic nerves and are more prone to cardiac and cerebrovascular accident.