阻塞性睡眠呼吸暂停低通气综合征相关性高血压舒张压及收缩压情况及影响因素分析

Diastolic and Systolic Blood Pressure in Hypertention Patients with Obstructive Sleep Apnea- hypopnea Syndrome and Influencing Factor

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）相关性高血压舒张压（DBP）、收缩压（SBP）的情况和影响因素.方法 选取2012年2月-2013年12月在南昌大学第二附属医院呼吸科门诊因打鼾行睡眠监测的291例患者,均经过询问病史、体格检查和多导睡眠监测,统一使用中华医学会呼吸病学分会睡眠呼吸疾病学组编制的《睡眠呼吸暂停与高血压发病情况问卷调查表》对受试者进行调查和规范血压测量.根据呼吸暂停低通气指数（AHI）分为OSAHS组（AHI≥5次/h）和非OSAHS组（AHI＜5次/h）.OSAHS患者又分为轻度OSAHS （AHI5～15次/h）、中度OSAHS（AHI16～30次/h）及重度OSAHS（AHI＞ 30次/h）患者.采用SPSS 19.0统计软件进行数据分析,采用x2检验比较OSAHS组与非OSAHS组的高血压患病率,评价不同程度OSAHS患者DBP、SBP情况,评价DBP、SBP与AHI、氧减指数（ODI）、平均血氧饱和度（MSaO2）及最低血氧饱和度（LSaO2）的相关性,采用Logistic回归分析对睡眠呼吸暂停危险因素进行分析.结果 OSAHS组高血压的患病率（59.1％,133/225）高于非OSAHS组（34.8％,23/66）,差异有统计学意义（x2=12.079,P=0.001）.重度OSAHS患者SBP、DBP水平均高于轻度OSAHS患者,差异有统计学意义（P＜0.05）.DBP与AHI呈正相关,与ODI、MSaO2、LSaO2呈负相关;SBP与AHI无相关关系,与ODI呈正相关,与MSaO2呈负相关.OSAHS的影响因素有：性别[OR =0.391,95％ CI （0.199,0.770）]、BMI[OR=1.165,95％CI （1.076,1.262）]、SBP[OR=0.966,95％CI （0.943,0.990）]、DBP[OR=1.068,95％ CI （1.030,1.109）].结论 OSAHS患者高血压患病率高,DBP与睡眠呼吸暂停患者病情严重程度密切相关,通过血压监测有助于早期发现OSAHS相关性高血压疾病.

Objective To understand the effects of the diastolic blood pressure （DBP） and systolic blood pressure （SBP） of hypertensive patients with obstructive sleep apnea- hypopnea syndrome （OSAHS） and analyze the influencing factors. Methods A total of 291 patients were selected for the study who were monitored in sleep because of snoring in the outpatient respiratory department, the Second Affiliated Hospital of Nanchang University from February 2012 to December 2013. The patients received medical history interview, physical examination and the polysomnography. In addition, they were also investigated by“Sleep Apnea and Hypertension Questionnaires”drafted by Sleep Apnea Disease Group, Chinese Society of Respiratory Disease, Chinese Medical Association and received standardized blood pressure measurement. They were divided into OSAHS group （AHI≥5 times/h） and non - OSAHS group （AHI 〈5 times/h） according to apea -hypopnea index （AHI） and then OSAHS group was sub - grouped into slight （ AHI 5 ～ 15 times/h）, middle （ AHI 16 ～ 30 times/h） and severe （ AHI 〉 30 times/h） . SPSS 19.0 software package was used for data analyzing, and prevalence rates of hypertension were compared by X2 test. DBP and SBP were evaluated in different degrees of OSAHS and the correlation of DBP and SBP ,with ODI, MSaO2 and LSaO2 was evaluated respectively and logistic regression was used for the risk factors analysis. Results The prevalence of hypertension was higher in OSAHS group （59.1%, 133/225） than that in non - OSAHS group （34. 8%, 23/66） and the difference was significant （ X2 = 12. 079, P =0. 001 ） . SBP and DBP in severe OSAHS patients were all significantly higher than that in mild OSAHS and the difference was significant （P 〈 0.05 ） . DBP was positively correlated with AHI, but negatively correlated with ODI, MSaO2 and LSaO2 ; SBP was not correlated with AHI, positively correlated with ODI but negatively with MSaO2. Independent risk factors had gender [ OR =0. 391, 95% CI （0. 199, 0. 770） ], BMI [ OR = 1. 165, 95% C1 （1. 076, 1.262））, SBP [OR=0.966, 95%C1 （0.943, 0.990）3 and DBP （OR=1.068, 95%CI （1.030, 1.109）3 .Conclusion OSAHS patients have higher prevalence of hypertension. There is a close relationship between sleep apnea syndrome and the DBP. Blood pressure monitoring may help early detection of OSAHS - related hypertension.