睡眠障碍与高血压患者血压变异性及冠心病的相关性分析

Correlation analysis of blood pressure variability and coronary heart disease in patients with hypertension

目的探讨睡眠障碍对高血压患者血压变异性及冠状动脉粥样硬化性心脏病(冠心病)的影响。方法入选2015年7月至2018年6月于烟台市莱阳中心医院心内科住院高血压受试者242例,年龄36~72岁,由同一研究小组完成24 h动态血压监测,依据匹茨堡睡眠指数(PSQI)量表对受试者睡眠状况进行评估分组,PSQI≤7分为睡眠良好组(n=155),PSQI>7分为睡眠障碍组(n=87),分析两组动态血压参数的差异,并评价血压波动状况与冠心病的关系。结果睡眠障碍组体质量指数、空腹血糖、糖化血红蛋白(HbA1c)、冠心病比例高于睡眠良好组(P<0.05或P<0.01)。睡眠障碍组异常血压节律比例高于睡眠良好组(72.4%vs.52.3%,χ^2=9.395,P=0.002)。睡眠障碍组24 h平均收缩压(24 hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台、清晨收缩压上升速度水平[(15.0±8.8)vs.(11.1±9.2)mmHg/h]高于睡眠良好组(P均<0.01),而夜间舒张压下降速度慢于睡眠良好组(P<0.05)。单因素相关分析显示:24 hSBP、白天收缩压平台、夜间收缩压平台和清晨收缩压上升速度与PSQI评分密切相关(r=0.481,0.370,0.390,0.208,P均<0.05)。睡眠障碍冠心病的患病率要高于睡眠良好组(57.5%vs.31.6%,P<0.001),在校正相关因素后,Logistic回归分析显示:吸烟(OR=6.023,95%CI:3.108~11.672,P<0.001)、睡眠障碍(OR=2.970,95%CI:1.618~5.452,P<0.001)、清晨收缩压上升速度(OR=1.048,95%CI:1.015~1.083,P=0.004)是冠心病的独立危险因素。结论睡眠障碍会升高高血压患者血压水平,加剧清晨血压波动及减慢夜间血压下降速度,睡眠障碍和清晨收缩压上升速度加快可能是冠心病发生的危险因素。

Objective To investigate the effects of sleep disorders on blood pressure variability and coronary heart disease in patients with hypertension.Methods From July 2015 to June 2018,242 patients with hypertension in the Department of Cardiology,Yantai Laiyang Central Hospital,aged 36 to 72 years,were selected by the same research team to perform 24-hour ambulatory blood pressure monitoring,based on the Pittsburgh Sleep Index.(PSQI)scale was used to evaluate the sleep status of the subjects.PSQI≤7 was divided into a good sleep group(n=155)and PSQI>7 was divided into a sleep disorder group(n=87).The differences were evaluated and the relationship between blood pressure fluctuations and coronary heart disease was evaluated.Results The proportions of body mass index,fasting blood glucose,glycated hemoglobin(HbA1c),and coronary heart disease in the sleep disorder group were higher than those in the good sleep group(P<0.05 or P<0.01).The proportion of abnormal blood pressure rhythm in the sleep disorder group was higher than that in the good sleep group(72.4%vs.52.3%,χ^2=9.395,P=0.002).The 24 h mean systolic blood pressure(24 hSBP),the day time mean systolic blood pressure(dSBP),the night time mean systolic blood pressure(nSBP),the day time systolic blood pressure platform,the night time systolic blood pressure platform,and the early morning systolic blood pressure increase rate in the sleep disorder group[(15.0±8.8)vs.(11.1±9.2)mmHg/h]was higher than that in the good sleep group(both P<0.01),and the diastolic blood pressure decreased at a slower rate than in the good sleep group(P<0.05).The univariate correlation analysis showed that 24hSBP,daytime systolic blood pressure platform,nighttime systolic blood pressure platform and early morning systolic blood pressure rise rate were closely related to PSQI scores(r=0.481,0.370,0.390,0.208,P<0.05).The prevalence of sleep disorder coronary heart disease was higher than that in the good sleep group(57.5%vs.31.6%,P<0.001).After adjusting for related factors,Logistic regression analysis showed that smoking(OR=6.023,95%CI:3.108~11.672,P<0.001),sleep disorders(OR=2.970,95%CI:1.618~5.452,P<0.001),and early morning systolic blood pressure rise rate(OR=1.048,95%CI:1.015~1.083,P=0.004)are independent risk factors of coronary heart disease.Conclusion Sleep disorder can increase the blood pressure level of hypertensive patients,aggravate blood pressure fluctuations in the morning and slow down the rate of blood pressure drop at night.Sleep disorders and accelerated rise of systolic blood pressure in the morning may be risk factors for coronary heart disease.