高血压患者慢波睡眠时长与夜间血压水平的相关性

Correlation between the Duration of Slow-wave Sleep and Nocturnal Blood Pressure Levels in Hypertensive Patients

目的探讨高血压患者慢波睡眠(SWS)时长与夜间血压水平的相关性。方法连续纳入2019年9~11月就诊于新疆维吾尔自治区人民医院高血压诊疗中心的住院患者201例,所有患者均完善24h动态血压测定和多导睡眠监测评价睡眠结构。按照SWS构成比中位数(9%)将患者分成两组,通过比较两组患者夜间血压水平及睡眠结构的差异明确SWS与夜间血压的关系。结果SWS构成比≤9%的患者夜间平均收缩压、夜间平均舒张压均明显高于SWS构成比>9%组(P<0.05)。两组间合并OSA的比例匹配,但SWS构成比≤9%的患者平均AHI、N2期睡眠较SWS构成比>9%组明显增加。夜间SBP和DBP水平与AHI呈正相关,而SWS与AHI呈负相关(r=-0.034,P=0.000),校正年龄、BMI、性别和是否合并OSA后,Logistic回归分析显示,与SWS构成比>9%比较,SWS构成比≤9%可以使夜间DBP>80mmHg的风险增加1.38倍(95%CI:1.25~4.27,P=0.008)。此外,男性是夜间收缩压和舒张压偏高的风险因素。结论高血压人群中慢波睡眠减少与夜间舒张压水平较高具有相关性。

Objective To investigate the correlation between the duration of slow wave sleep(SWS)and nocturnal blood pressure levels in hypertensive patients.Methods Consecutive 201 inpatients attending the hypertension treatment center of the People′s Hospital of Xinjiang Autonomous Region from September to November 2019 were included,and all patients were perfected with 24-hour ambulatory blood pressure measurement and polysomnography to evaluate sleep structure.Patients were divided into two groups according to the median SWS composition ratio(9%),and the relationship between SWS and nocturnal blood pressure was clarified by comparing the differences in nocturnal blood pressure levels and sleep structure between the two groups.Results The mean nocturnal systolic blood pressure(SBP)and mean nocturnal diastolic blood pressure(DBP)were significantly higher in patients with SWS composition ratio≤9%than in the SWS>9%group(P<0.05).The proportion of combined OSA was matched between the two groups,but the mean AHI was significantly higher in patients with SWS composition ratio≤9%and N2 sleepcompared with the SWS>9%group.Nocturnal SBP and DBP levels were positively correlated with AHI,while SWS was negatively correlated with AHI(r=-0.034,P=0.000),and after adjusting for age,BMI,gender and presence of comorbid OSA,Logistic regression showed that a SWS composition ratio≤9%could increase the risk of nocturnal DBP>80mmHg compared to a SWS composition ratio>9%1.38-fold(95%CI:1.25-4.27,P=0.008).In addition,man wasa risk factor for high nocturnal systolic and diastolic blood pressure.Conclusion Reduced slow-wave sleep correlates with higher nocturnal diastolic blood pressure levels in a hypertensive population.