睡眠呼吸暂停综合征与高血压

The association of sleep apnea syndrome with blood pressure

目的 研究睡眠呼吸暂停综合征 (SAS)对 2 4h血压的影响。方法 同步进行 2 4h动态血压和多导睡眠检查 ,选择未用药或停服血管活性药 2周患者 5 6例 ,按呼吸紊乱指数 (AHI)分为正常、轻度SAS和中重度SAS三组 ,比较AHI与 2 4h血压参数的关系。结果 多元回归显示 ,AHI与白天收缩压、舒张压 (P <0 0 5 ,P <0 0 0 1)、夜间收缩压、舒张压 (P <0 0 0 1,P <0 0 0 1)及夜间血压下降百分数显著相关 (P <0 0 0 1,P <0 0 5 )。协方差分析结果显示 ,AHI增加 ,白天血压升高 ,与正常组和轻度SAS组相比 ,中重度SAS组夜间血压下降百分数减少 (P <0 0 5 )。结论 SAS可能是高血压病的危险因素之一 ,并独立于年龄和体重。在中、重度SAS患者中 ,出现血压生理节律的改变 ,这些改变与SAS患者心脑血管发病率和死亡率增加有关。

Objective To study the influence of sleep apnea syndrome (SAS) on 24h blood pressure. Methods 24h ambulatory blood pressure monitoring (ABPM) and polysomnography was simultaneously used to analyze 56 patients who received no antihypertensive medicine or discontinued treatment 14 days prior to the test. The relationship between SAS and hypertension was analyzed. Results Correlation analysis showed that apnea/hypopnea index (AHI) was related to systolic and diastolic BP in daytime (P<0.05, P<0.01) and in nighttime (P<0.001, P<0.001) as well as day-night/day ratios (P<0.001, P<0.05). AHI was independently related to systolic and diastolic BP in daytime. When subjects were grouped according to AHI, daytime BP increased as AHI increase. Compared with subjects with mild SAS or normal controls, BP night-day/day ratios were greater in patients with moderate to severe SAS (P<0.05). Conclusion SAS is associated with hypertension independent of age and body weight . Nodipper is related to apnea severity. In patients with severe SAS there is change in physical rhythm of BP, which might contribute to the increased morbidity and mortality of cardio-cerebrovascular disease in patients with SAS.