阻塞性睡眠呼吸暂停综合征相关高血压病的临床特点

Clinical Characterstics of Obstructive Sleep Apnea Associated Hypertension

探讨阻塞性睡眠呼吸暂停综合征相关性高血压病 (obstructive sleep apnea associated hypertension,OSAAHT)的临床特点。对照分析 2 4例 OSAAHT和年龄及病期相匹配的 2 2例原发性高血压病患者 ,比较症状、体重指数、治疗前睡眠前后血压变化及 2 4h血压动态监测等指标。结果发现 OSAAHT患者白天明显过度困倦 ,睡眠监测呼吸紊乱指数 (AHI)为 (4 5 .1± 15 .3)次 / h,体重指数高于对照组 [(2 7.9± 2 .5 ) kg/ m2比 (2 3.9± 1.7) kg/ m2 ,P<0 .0 1]。OSAAHT睡前血压 (137.1± 10 .5 ) / (88.4± 6 .6 ) mm Hg,清晨血压 (15 5 .9± 14.4) / (10 1.8± 4.9) m m Hg;原发性高血压病组睡前血压 (149.2± 12 .5 ) / (91.7± 6 .2 ) mm Hg,清晨血压 (140 .7± 9.4) / (83.4± 5 .9) mm Hg;两组睡前收缩压及清晨收缩压和舒张压均有差异 ,P<0 .0 1。OSAAHT夜间血压下降率明显小于原发性高血压病对照组[(13.3± 4.9) %比 (4 .5± 1.6 ) % ,P<0 .0 1]。提示 OSAAHT除了睡眠呼吸障碍外 ,还具有以下临床特点 :清晨睡醒时血压较高 ,夜间血压下降幅度变小 。

In order to explore the clinical features of obstructive sleep apnea associated hypertension (OSAAHT), 24 cases of OSAAHT were compared to 22 age and disease severity matched cases of primary hypertension with regard to symptoms, variability of blood pressure (Bp) level a day and body mass index (BMI). The patients with OSAAHT were more sleepiness in daytime, and had, usually severe, sleep apnea with apnea and hypopnea index (AHI) being 45.1±15.3/h. The BMI in the OSAAHT patients [(27.9±2.5) kg/m 2] was higher than in the control group [(23.9±1.7) kg/m 2, P<0.01]. The Bp levels before sleep in the patients with OSAAHT or primary hypertension were (137.1±10.5)/(88.4±6.6) and (149.2±12.5)/(91.7±6.2) mmHg respectively (P<0.01) and those after sleep were (155.9±14.4)/(101.8±4.9) and (140.7±9.4)/(83.4±5.9) mmHg respectively (P<0.01). The rate of Bp dip overnight in the patients with OSAAHT [(13.3±4.9) %] was significantly less than in the patients with primary hypertension [(4.5±1.6) %,P<0.01]. It was concluded that in addition to sleep disordered breathing, patients with OSAAHT were characterized by the following clinical features: daytime sleepiness, obese, higher level of Bp in the morning after sleep and a little Bp dip during night.