阻塞性睡眠呼吸暂停综合征与高血压的关系初探

To Explore Relationship Between Obstructive Sleep Apnea Syndrome and Hypertension

目的 认识打鼾患者睡眠时血压的改变 ,初步探讨阻塞性睡眠呼吸暂停综合征 (OSAS)与高血压之间的关系。方法 对 2 6 6例打鼾者进行Autoset诊疗系统监测及睡前、醒后肘部血压测定 ,16 6例诊断为OSAS患者作为OSAS组 ,10 0例未达到诊断标准者作为对照组 ,对两组进行上述各项指标的统计学处理 ,同时对OSAS伴高血压患者治疗 6个月左右 ,重复上述测定。结果 OSAS组睡前血压 (12 8 94± 19 32 /87 46± 12 30 )mmHg至次晨醒后血压 (139 6 6± 19 38/99 6 8± 16 2 8)mmHg明显升高 (P <0 0 1) ,与对照组睡前血压 (116 12± 11 17/78 2 2±10 18)mmHg及醒后血压 (116 76± 15 42 /78 6 6± 10 94)mmHg比较呈显著性升高 (P <0 0 1) ,OSAS组最低SaO2 (6 2 38± 18 2 4) % ,较对照组最低SaO2 (89 46± 7 6 6 ) %显著降低 (P <0 0 1) ,OSAS组有 88例 (5 3% )确诊为高血压病 ,经鼻面罩持续正压通气 (nCPAP)治疗 6个月有 5 2例患者血压明显下降 ,其中 2 7例患者血压恢复正常。结论 OSAS患者的低氧血症可能是相当部分OSAS伴发高血压的发病原因 ,nCPAP治疗有助于此类患者血压的恢复 ,本文对OSAS引起血压升高的机制作了初步探讨。

Objective To explore the changes of arterial pressure in patients with snore during sleep and to increase the acknowledge for the relationship between obstructive sleep apnea syndrome(OSAS) and hypertension(HT).Methods 266 patients with snoring were monitored during overnight nocturnal sleep monitored with Autoset diagnosis-treatment system and measured arterial pressure before and after sleep.166 patients of them as OSAS group,the other 100 patients as controls.Data for each group such as Apnea Index,SaO 2 and arterial pressure were chosen for statistical analysis.Results The blood pressure in OSAS group before sleep was(128 94±19 32/87 46±12 30)mmHg,after sleep was(139 66±19 38/99 68±16 28)mmHg(P<0 01).On the contrary,changes of arterial pressure in the controls had no significant difference before and after sleep[from(116 12±11 17/78 22±10 18)mmHg before sleep to(116 76±15 42/78 66±10 94)mmHg after sleep].The blood pressure in the OSAS group was increased remarkably than that in the controls(P<0 01).The lowest SaO 2 in the OSAS group was decreased remarkably than that of the controls.[from (62 38±18 24)% to (89 46±7 66)%,P<0 01],88 cases(53%) in the OSAS group were diagnosed as essential hypertension.But 52 cases blood pressure levels were decreased after effective nCPAP treatment for six months,27 cases of them recover to normal level.Conclusions The nocturnal hypoxemia may be considered as one of the causes of some OSAS patients with hypertension.Through nCPAP treatment,the hypertension may be recovered to normal value in the OSAS.The paper is to explore the mechanism of increasing blood pressure in the OSAS.