老年阻塞性睡眠呼吸暂停低通气综合征患者血压和心电图改变的分析

Changes of blood pressure and electrocardiogram in elderly patients with obstructive sleep apnea hypopnea syndrome

目的通过检查测量患有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的中老年人群血管内壁压力和心电图走向的变化,探究其与心血管疾病的相互关系,以求为某些心血管疾病合并有OSAHS患者的治疗提供依据.方法以在解放军总医院住院的老年患者为对象,选取67例进行睡眠监测,并于次日上午8:00开始检测24h动态心电图和24小时动态血压.结果患者的年龄和OSAHS的发病程度之间呈正相关的关系,差异较为明显.对照组与不同程度OSAHS组在24h平均舒张压(24hMDP)、日间平均舒张压(dMDP)、夜间平均舒张压(nMDP)、日间平均动脉压(dMAP)等方面差别均无统计学意义.重度OSAHS实验组与其他实验组相比明显升高(P<0.05)的数值有24h内患者平均血压中血管收缩压(24hMSP)、24h患者平均收缩压和舒张压之间的差(24hPP)、患者日平均收缩压(dMSP)、日间平均收缩压和舒张压的差值(dPP)、患者夜间平均的动脉压(nMSP)以及患者夜间平均脉压的差值(nPP).与实验中的对照组做比较,不管是轻度、中度还是重度OSAHS组人群中非杓形血压的患病概率都有明显的上升(P<0.05).动态心电图结果提示与对照组相比,ST-T发生改变和出现各种类型心律失常在各OSAHS组均显著升高.结论老年OSAHS患者收缩压和平均动脉压出现显著升高,血压的正常节律改变,还易引发ST-T改变和各类型心律失常,属心血管疾病的危险因素之一.

0bjective To evaluate changes of blood pressure,and electrocardiogram(ECG)in elderly patients with obstructive sleep apnea-hypopnea syndrome(OSA HS)and investigate the relationship between OSAHS and cardiovascular diseases(CVD).Methods 67 elderly patients with OSAHS were divided into 4 groups according to apnea-hypopnea index(AHI)measured by polysomnography.We collected 15 cases with AHI<5 times/h(control group),24 cases with AHI 5-20 times/h(mild OSAHS group),13 cases with AHI 20~40 times/h(moderate OSAHS group),15 cases with AHI>40 times/h(severe OSAHS group).24-hour ambulatory blood pressure and dynamic ECG were performed in the patients.Results The severity of OSAHS was positively correlated with age(P<0.05).BMI,TC,TG,HDL-C and LDL-C were not significantly different in 4 groups.24hMDP,dMDP,nMDP and dMAP were not significantly different in 4 groups.Compared with control group and mild,moderate OSAHS groups,24hMSP,dMSP,nMSP,24hPP,dPP and nPP were significantly higher in severe OSAHS group.The incidence of non-dipper blood pressure was higher in three OSAHS groups than in the control group.The incidence of arrhythmia and ST-T changes in all three OSAHS groups were higher than that of the control group.Conclusion OSAHS increases blood pressure in the elderly patients,especially systolic blood pressure and pulse pressure.It also influences blood pressure circadian rhythm.OSAHS may trigger a variety of arrhythmias and ST-T changes.All above prompt OSAHS may he a risk factor for cardiovascular diseases.