阻塞性睡眠呼吸暂停低通气综合征合并高血压患者皮质下觉醒反应特点分析

Study on the characteristic of subcortical arousal response in patients with obstructive sleep apnea hypopnea syndrome and hypertension

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者皮质下觉醒反应特点。方法选择2015年10月~2016年6月在新疆自治区人民医院高血压中心住院的120例高血压患者,所有患者均行夜间多导睡眠监测,同时测定脉搏传导时间(PTT)以评估患者皮质下觉醒反应。根据呼吸暂停低通气指数(AHI),将研究对象分为无OSAHS组(17例)、轻度OSAHS组(21例)、中度OSAHS组(34例)和重度OSAHS组(48例)。对四组OSAHS相关参数、PTT觉醒指数进行统计分析。结果重度OSAHS组总PTT觉醒指数(PTTt)、呼吸相关性PTT觉醒指数(PTTr)、睡眠非快动眼期PTT觉醒指数(PTT-NREM)高于其余各组,PTT最小值低于其余各组(P<0.05)。各组间非呼吸相关性PTT觉醒指数(PTTn)、PTT平均值比较,差异无统计学意义(P>0.05)。PTTt、PTTr、PTT-REM、PTT-NREM与AHI、氧减指数、脑电觉醒指数呈正相关,与最低血氧饱和度(min Sa O2)呈负相关(P<0.05)。PTTn与AHI、min Sa O2、脑电觉醒指数、氧减指数之间无相关性(P>0.05)。无OSAHS组与轻中度OSAHS患者PTT-REM明显高于PTT-NREM(P<0.05)。结论在OSAHS合并高血压患者中PTT觉醒指数是一个客观的监测指标,其中PTTr是判断OSAHS严重程度的更为敏感的指标。

Objective To investigate the characteristics of subcortical arousal response in patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and hypertension. Methods From October 2015 to June 2016, 120 hypertensive inpatients in the Hypertension Center, the People′s Hospital of Xinjiang Uygur Autonomous Region were selected.Polysomnography was underwent and pulse transit time（PTT） was measured in all patients to assess subcortical arousal response. According to the apnea hypopnea index（AHI）, the cases were divided into four groups： non-OSAHS group（17 cases）, mild OSAHS group（21 cases）, moderate OSAHS group（34 cases） and severe OSAHS group（48 cases）. The parameters of OSAHS and PTT of four groups were analyzed. Results In severe OSAHS group total PTT arousal index（PTTt）, respiratory related PTT arousal index（PTTr）, PTT arousal index in NREM（PTT-NREM） significantly increased compared with the other groups, minimum PTT value significantly decreased compared with the other groups（P〈0.05）.There was no statistically difference between groups in non respiratory related PTT arousal index（PTTn）, the average value of PTT（P〈0.05）. PTTt, PTTr PTT-REM, PTT-NREM were positively correlated with AHI, oxygen desaturation index, EEG arousal index and negatively correlated with min Sa O2（P〈0.05）. There was no correlation between PTTn and AHI, min Sa O2, EEG arousal index and oxygen desaturation index（P〈0.05）. PTT-REM was significantly higher than PTTNREM in non-OSAHS group, mild and moderate OSAHS group（P〈0.05）. Conclusion PTT arousal index is an objective value and respiratory related PTT arousal index is more sensitive in judging the severity of OSAHS in OSAHS with hypertension patients.