动态心电图在高血压合并阻塞性睡眠呼吸暂停低通气综合征患者初步筛查中的应用

Application of dynamic electrocardiograph in screening hypertension patients with obstructive sleep apnea hypopnea syndrome

目的探讨动态心电图推导的呼吸曲线(EDR)在高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者初步筛查中的应用价值。方法选择本院高血压且存在打鼾症状的患者85例,行多导睡眠监测(夜间记录时间>7 h),同步进行动态心电图检查。睡眠监测通过人工分析、动态心电图通过推导曲线分别计算呼吸睡眠呼吸暂停低通气指数(AHI),做出OSAHS阳性或阴性的诊断。以多导睡眠监测为标准,将高血压患者分为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)阳性组64例和OSAHS阴性组21例,观察OSAHS阳性组患者高血压特征及难治性高血压发生率。结果 OSAHS阳性组患者醒后收缩压及舒张压均较OSAHS阴性组显著增高(P<0.05);OSAHS阳性组患者醒后舒张压较睡前显著增高(P<0.01)。OSAHS组患者难治性高血压发生率显著高于非OSAHS组;应用动态心电图的EDR技术诊断OSAHS的敏感性84.40%,特异性90.50%,阳性预测值96.40%,阴性预测值65.50%,初筛符合率85.90%。结论 OSAHS是导致难治性高血压的重要原因之一,利用动态心电图EDR技术初筛高血压合并OSAHS患者简单可行。

Objective To explore clinical significance of dynamic electrocardiograph monitoring for screening of obstructive sleep apnea hypopnea syndrome（ OSAHS） in hypertensive patients.Methods A total of 85 hypertension patients with snoring were selected,conducted with polysomnography（ PSG） for 7 h in nighttime recording time and 24 h ambulatory electrocardiogram（ AECG）monitoring simultaneously. The PSG was tested by using manual analysis,and AECG was evaluated by using EDR,and positive and negative diagnosis of obstructive sleep apnea and hypopnea syndrome（ OSAHS） were determined. Based on the PSG results,these patients were divided into OSAHS positive groups with 64 hypertensive patients and OSAHS negative group with 21 patients,and the features of hypertension and the incidence of resistant hypertension in OSAHS patients were observed.Results The systolic blood pressure and diastolic blood pressure after waking in OSAHS positive group were significantly higher than that in OSAHS negative group（ P〈0. 05）. The diastolic blood pressure in the OSAHS positive group increased remarkably after waking（ P 〈0. 01）. The incidence of refractory hypertension in the OSAHS positive group was higher than that in OSAHS negative group. The EDR diagnosis results showed that the sensitivity and specificity of OSAHS was 84. 40%,90. 50%,respectively,and the positive and negative predictive value were 96. 40%,65. 50%,respectively,and the diagnose accordance rate was 85. 90%. Conclusion OSAHS maybe one of the important causes leading to refractory hypertension,EDR technique is easy and feasible to screen the suspicious OSAHS in hypertensive patients.