老年住院患者睡眠呼吸紊乱相关非杓型高血压危险因素分析

Risk factors of non-dipper hypertension associated with sleep-disordered breathing in elderly inpatients

目的探讨老年睡眠呼吸紊乱患者发生非杓型高血压的危险因素。方法选择扬州大学临床医学院2019年7月至2020年12月收治的124例老年睡眠呼吸紊乱相关的高血压患者为研究对象,根据昼夜血压下降比率,将患者分为杓型高血压组(61例)和非杓型高血压组(63例)。采用SPSS 23.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用logistic回归法分析影响非杓型高血压形成的危险因素。结果非杓型高血压组颈围、体质量指数(BMI)、24h平均收缩压(24h MSBP)、夜间平均收缩压(nMSBP)、24h平均脉压差(24h MPP)、呼吸紊乱指数(AHI)、呼吸暂停次数、氧减指数(ODI)、脉氧下降率、颈动脉内膜中层厚度(CIMT)明显高于杓型组(组内左侧比右侧更为显著);夜间最低氧饱和度(LSaO_(2))明显低于杓型组,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,ODI(OR=1.423,95%CI,1.230~2.566,P<0.001)、CIMT(OR=1.965,95%CI,1.031~2.752,P<0.001)、脉氧下降率(OR=1.676,95%CI,1.007~2.889,P<0.001)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。结论睡眠呼吸紊乱与夜间血压节律的改变明显相关,ODI、CIMT、脉氧下降率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。降低夜间高血压,将非杓型调整为杓型昼夜节律,改善睡眠质量对合并有睡眠呼吸紊乱的非杓型高血压患者大有裨益。

Objective To investigate the risk factors of non-dipper hypertension in elderly patients with sleep-disordered breathing.Methods A total of 124 elderly inpatients with hypertension associated with sleep-disordered breathing in Clinical Medical College of Yangzhou University from July 2019 to December 2020 were recruited in this study,and then divided into dipper hypertension group(n=61)and non-dipper hypertension group(n=63)according to the rate of blood pressure decrease during day and night.SPSS statistics 23.0 was used to perform the statistical analysis.Student′s t test or Chi-square test was employed for intergroup comparison based on different data types.Logistic regression analysis was adopted to analyze the risk factors for non-dipper hypertension.Results As compared with the dipper hypertension group,the non-dipper hypertension group had significantly larger neck circumference and body mass index(BMI),and higher 24-hour mean systolic blood pressure(24h MSBP),nocturnal mean SBP(nMSBP),24h mean pulse pressure difference(24h MPP),apnea hypopnea index(AHI),times of apnea,oxygen desaturation index(ODI),pulse oxygen decline rate,and carotid intima-media thickness(CIMT,with the left side more obvious than the right one in same group),but remarkably lower lowest oxygen saturation(LSaO_(2))at night(P<0.05).The results of logistic regression analysis showed that ODI(OR=1.423,95%CI 1.230-2.566,P<0.001),CIMT(OR=1.965,95%CI 1.031-2.752,P<0.001)and pulse oxygen decline rate(OR=1.676,95%CI 1.007-2.889,P<0.001)were risk factors for non-dipper hypertension in elderly patients with sleep-disordered breathing.Conclusion Sleep disordered breathing is significantly related to the change of nocturnal blood pressure rhythm.ODI,CIMT and pulse oxygen decline rate are important risk factors for no-dipper hypertension in elderly patients with sleep-disordered breathing.Reducing nocturnal hypertension,djusting non-dipper to dipper circadian rhythm,and improving sleep quality are of great benefit to these patients.