睡眠状况对老年高血压患者血压节律的影响

Effects of sleep situation on circadian rhythm of blood pressure in elderly patients with hypertension

目的研究老年高血压患者睡眠状况对血压节律的影响。方法连续入选2016年10－12月在解放军总医院住院并诊断为高血压患者230例（年龄≥60岁）。采集患者一般临床资料和化验结果，并进行匹兹堡睡眠质量指数量表（PSQI）调查。根据入院后动态血压的昼夜节律特点，将患者分为反杓型组110例、非杓型组86例、杓型组34例，比较组间临床资料和睡眠状况，并分析睡眠状况对血压节律的影响。结果在PSQI评分的7个因素中，除催眠药物其余因素在不同血压节律组中差异有统计学意义。杓型组的评分低于反杓型组、非杓型组，睡眠状况好于其他两组（P〈0.05）。多重线性回归分析结果显示，校正高血压的常见危险及影响因素后，PSQI评分与夜间血压下降率呈负相关（β＝－0.651，P〈0.01）；进一步校正了PSQI评分的7个组分后，睡眠时间评分仍与夜间血压下降率呈负相关（β＝－1.926, P＝0.031），睡眠时间短的老年高血压患者夜间下降率低，易发生反杓型和非杓型血压节律异常。结论老年高血压患者睡眠质量差，尤其是睡眠时间短的患者更易出现反杓型和非杓型的血压昼夜节律异常。睡眠时间不足可作为血压昼夜节律异常的预测因子。

ObjectiveTo explore the effects of sleep situation on circadian rhythm of blood pressure in elderly hypertension patients. MethodsTwo hundred and thirty patients （aged ≥60 years） with hypertension treated in the Department of Geriatric Cardiology of PLA General Hospital were enrolled in the study from October 2016 to December 2016. After admission, the clinical and laboratory tests data and examinations of the patients were collected and analyzed. The patients＇ sleep was investigated by Pittsburgh sleep quality index （PSQI）. The ambulatory blood pressure rhythm was divided into three groups： reverse-dipper group （n=110）, non-dipper group （n=86）, and dipper group （n=34）. The clinical data and sleep situation of different blood pressure rhythm groups were compared, and the effects of sleep situation on different blood pressure rhythm were analyzed.ResultsThe total PSQI score with six domains[P〈0.01, except hypnotic drug （P〉0.05）]was significantly lower in dipper group than in reverse-and non-dipper group.The sleep situation was significantly better in dipper group than in reverse-and non-dipper group （P〈0.05）. Multiple linear regression analysis showed a significant negative correlation between total PSQI score and nocturnal blood pressure drop after adjusting for risk factors of hypertension （β= -0.651, P〈0.01）. Furthermore, after further adjusting for the seven domains of the PSQI score, the negative correlation remained between the sleep time score and the nocturnal blood pressure drop （β= -1.926, P=0.031）. The elderly hypertension patients with shorter sleep duration had a lower rate of nocturnal blood pressure decline, and were prone to present the reverse-dipper and non-dipper blood pressure rhythm.ConclusionsThe elderly hypertension patients with poor sleep quality, especially with short sleep duration, are prone to present the reverse-dipper and non-dipper blood pressure rhythm.Short sleep duration can be used as a predictor for abnormal blood pressure rhythm.