睡眠呼吸相关老年高血压患者夜间脉氧下降率与血压变异性的相关性及危险因素研究

Correlation and risk factors of nocturnal pulse oxygen decline rate and blood pressure variability in elderly patients with sleep breathing related hypertension

目的:探讨老年睡眠呼吸紊乱患者的夜间脉氧下降率与昼夜血压变异的相关性及其形成非杓型高血压的危险因素。方法:纳入本院2019年7月—2020年12月收治的166例睡眠呼吸紊乱相关的老年高血压患者,依据夜间血压下降百分率(PER),分为杓型高血压组和非杓型高血压组。夜间呼吸暂停事件发生后,氧减事件中每秒脉搏血氧饱和度(SpO_(2))下降的百分比作为脉氧下降率,比较两组睡眠呼吸相关指标、昼夜血压水平及临床各项数据的差异。采用Pearson相关分析评估脉氧下降率与昼夜血压变异的相关性;采用多元线性回归分析影响非杓型高血压形成的危险因素。结果:166例睡眠呼吸紊乱相关老年高血压患者中,非杓型高血压所占比例显著高于杓型血压(63.3%∶36.7%,P<0.05);非杓型高血压组的夜间舒张压短时血压变异性(nDBPARV)、夜间收缩压短时血压变异性(nSBPARV)、日间舒张压短时血压变异性(dDBPARV)、日间收缩压短时血压变异性(dSBPARV)均大于杓型高血压组,两组比较差异具有统计学意义(P<0.05);非杓型高血压组患者的呼吸紊乱指数(AHI)、氧减指数(ODI)、脉氧下降率显著高于杓型高血压组,最低血氧饱和度(LSaO_(2))水平显著低于杓型高血压组,其差异具有统计学意义(P<0.05);非杓型高血压组颈动脉内膜中层厚度(CIMT)大于杓型血压组,两组差异有统计学意义(P<0.05)。且同组组内左侧CIMT(LCIMT)较右侧CIMT(RCIMT)增厚,两组差异有统计学意义(P<0.05);非杓型高血压组nDBPARV以及nSBPARV与脉氧下降率、CIMT、AHI、ODI、BMI均呈正相关,与LSaO_(2)呈负相关。结论:老年睡眠呼吸紊乱患者的夜间脉氧下降率与夜间血压变异程度密切相关;脉氧下降率、ODI是老年睡眠呼吸紊乱患者发生非杓型高血压的重要危险因素。

Objective:To investigate the correlation between nocturnal pulse oxygen decline rate and blood pressure rhythm of day and night,and to investigate risk factors of non-dipper hypertension in elderly patients with sleep disordered breathing.Methods:From July 2019 to December 2020,166 elderly hypertensive patients with sleep-disordered breathing were divided into the non-dipper group and the dipper group according to the percentage of nocturnal blood pressure decrease(PER).After nocturnal apnea,the percentage of SpO_(2)reduction in the oxygen reduction event was taken as the pulse oxygen decrease rate.The differences of sleep breathing-related indexes,circadian blood pressure and clinical data between the two groups were compared.Pearson correlation analysis was used to evaluate the correlation between the decline rate of pulse oxygen and diurnal blood pressure variability.Multiple linear regression analysis was used to analyze the risk factors of non-dipper hypertension.Results:The proportion of non-dipper was significantly higher than that of dipper hypertension(63.3%vs.36.7%,P<0.05).The values of nDBPARV,nSBPARV,dDBPARV,and dSBPARV in the non-arytenoid group were significantly higher than those in the dipper hypertension group(all P<0.05).The levels of AHI,ODI,and decreased rate of pulse oxygen in the non-dipper group were significantly higher than those in the dipper hypertension group,and the level of LSaO_(2)was significantly lower than that in the non-dipper group(all P<0.05).The carotid intima-media thickness(CIMT)in the non-dipper group was significantly greater than that in the dipper hypertension group(P<0.05).In the same group,LCIMT was significantly thicker than RCIMT(P<0.05).In the non-dipper group,nDBPARV and nSBPARV were positively correlated with pulse oxygen reduction rate,CIMT,AHI,ODI,and BMI,while negatively correlated with LSaO_(2).Conclusion:Nocturnal pulse oxygen desaturation rate is strongly associated with the degree of nocturnal blood pressure variability in elderly patients with sleep-disordered breathing.Pulse oxygen desaturation rate and ODI are important risk factors for developing non-dipper hypertension in elderly patients with sleep-disordered breathing.