睡眠呼吸暂停综合征合并高血压病人的临床特点分析

Clinical Characteristics of Patients with Sleep Apnea Syndrome Complicated with Hypertension

目的:探讨睡眠呼吸暂停综合征(OSAHS)合并高血压病人血压变化特点、心脏重构指标的变化及其临床意义。方法:采用病例对照研究方法,选取自贡市精神卫生中心2018年3月—2021年3月确诊的96例OSAHS合并高血压病人作为观察组,另外选取100例单纯原发性高血压病人作为对照组,比较两组24 h动态血压指标、左心室重构结构指标、左心室收缩舒张功能指标,并根据睡眠呼吸暂停低通气指数(AHI)将观察组分为轻中度组和重度组,比较轻中度组和重度组24 h动态血压指标、左心室重构结构指标、左心室收缩舒张功能指标。结果:观察组和对照组日间平均收缩压(dSBP)、日间平均舒张压(dDBP)、夜间平均舒张压(nDBP)比较,差异均无统计学意义(P>0.05);观察组夜间平均收缩压(nSBP)、24 h平均收缩压(24 hSBP)均高于对照组,最低血氧饱和度(LSaO2)低于对照组,差异均有统计学意义(P<0.05);观察组和对照组左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)比较,差异均无统计学意义(P>0.05);观察组室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)、左心室收缩末期容积(LVESV)均高于对照组,左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、二尖瓣血流频谱舒张早期最大血流速度/二尖瓣血流频谱舒张晚期最大血流速度(E/A)均低于对照组,差异均有统计学意义(P<0.05)。重度组和轻中度组dSBP、dDBP、nDBP、24 hDBP、24 hSBP比较,差异均无统计学意义(P>0.05);重度组nSBP均高于轻中度组,LSaO2低于轻中度组,差异均有统计学意义(P<0.05);重度组和轻中度组LVESD、LVEDD比较,差异均无统计学意义(P>0.05);重度组IVST、LVPWT、LVMI、LVESV均大于轻中度组,重度组LVEF、LVEDV、E/A均低于轻中度组,差异均有统计学意义(P<0.05)。结论:OSAHS合并高血压病人的血压波动更大,对靶器官心脏的损害程度更为严重。

Objective:To investigate the characteristics of blood pressure changes and cardiac remodeling indexes in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with hypertension.Methods:The case-control study method was used,96 OSAHS patients with hypertension diagnosed in Zigong Mental Health Center from March 2018 to March 2021 were selected as observation group,and another 100 patients with simple primary hypertension were selected as control group.The ambulatory blood pressure indicators,left ventricular remodeling structure indicators,and left ventricular systolic and diastolic function indicators were compared between the two groups.According to the apnea hypopnea index(AHI),the observation group was divided into mild-moderate group and severe group.The 24-hour ambulatory blood pressure indexes,left ventricular remodeling structural indexes,and left ventricular systolic and diastolic function indexes were compared between mild-moderate group and severe group.Results:There were no significant differences in daytime mean systolic blood pressur(dSBP),daytime mean diastolic blood pressure(dDBP),and nighttime mean diastolic blood pressure(nDBP)(P>0.05).The nighttime mean systolic blood pressure(nSBP)and mean 24-hour systolic blood pressure(24 hSBP)in observation group were higher than those in control group,and the minimum oxygen saturation(LSaO2)in observation group was lower than that in control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD)between the two groups(P>0.05).The interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular mass index(LVMI),and left ventricular end-systolic volume(LVESV)in observation group were higher than those in control group,the left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),and the early diastolic blood flow velocity of mitral valve orifice(E)/the late diastolic blood flow velocity of mitral valve orifice(A)in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).There were no significant differences in dSBP,dDBP,nDBP,24 hDBP,and 24 hSBP between severe group and mild-moderate group(P>0.05).The nSBP of severe group was higher than that of mild-moderate group,and the LSaO2 was lower than that of mild-moderate group,and the differences were statistically significant(P<0.05).There was no significant difference in LVESD and LVEDD between severe group and mild-moderate group(P>0.05).The IVST,LVPWT,LVMI,and LVESV in severe group were higher than those in mild-moderate group,and the LVEF,LVEDV,and E/A in severe group were lower than those in the mild-moderate group,and the differences were statistically significant(P<0.05).Conclusion:The blood pressure of OSAHS patients with hypertension shows wider range fluctuation,and the damage of the target organ heart is more serious.