OSAHS对老年高血压患者内皮功能的影响

The effects of obstructive sleep apnea-hypopnea syndrome on endothelial function in elderly hypertensive patients

目的探讨阻塞性睡眠呼吸暂停综合症(OSAHS)对老年高血压患者血清大内皮素-1(ET-1)和一氧化氮(NO)表达的影响。方法入选就诊的144例老年高血压患者,平均年龄(67.5±5.8)岁。根据是否合并OSAHS分为OSAHS组(n=96)和非OSAHS组(n=48),收集患者体质量指数(BMI)、24 h动态血压参数、当前服药情况等基线资料。晚7时和次日晨7时采血,用酶联免疫吸附法检测血清NO和ET-1水平,行多导睡眠监测,并监测患者睡眠中动脉血氧饱和度。结果 2组间BMI、睡眠时间、24 h收缩压和舒张压、清醒血压、睡眠血压及服药情况差异无统计学意义。晚7时血清大ET-1和NO水平差异无统计学意义,但晨7时血清大ET-1水平高于非OSAHS组。在OSAHS组,平均动脉血氧饱和度与24 h收缩压(r=-0.44,P<0.05)和大ET-1(r=-0.41,P<0.05)呈负相关。结论 OSAHS对老年高血压患者血压和BMI无明显影响,合并OSAHS可使老年高血压患者,睡眠后血清大ET-1水平升高,但对NO水平无明显影响。

Objective To evaluate the levels of big endothelin- 1( Big ET- 1) and nitric oxide( NO) in elderly hypertensive patients with and without moderate to severe obstructive sleep apnea- hypopnea syndrome( OSAHS). Methods 144 hypertension subjects were enrolled from our hospital from August 2010 to July 2013. The mean age were 65. 5 ± 5. 8years. Based on OSAHS,the subjects were divided into with OSAHS group( n = 96) and without OSAHS group( n = 48). We obtained the following data: body mass index( BMI); 24- ambulatory blood pressure monitoring; and current medication. Arterial blood was collected at 7pm and 7am for determining plasma NO and Big ET- 1 levels. Pulse oximetry was performed during sleep. Results No significant differences were observed between the groups in BMI,number of hours of sleep,24- h systolic and diastolic BP,awake BP,sleep BP and medications. No differences were detected in plasma Big ET- 1 and NO levels at 19: 00 h,but plasma Big ET- 1 levels at 7: 00 h were higher in OSAHS group. In OSAHS group,a negative correlation was also observed between the mean arterial oxyhemoglobin saturation level,24- h systolic BP( P = 0. 03,r = 0. 44),and Big ET- 1( P = 0. 04,r =- 0. 41). Conclusion The elderly hypertensive patients with and without OSAHS have similar BP and BMI,but higher Big ET- 1 levels after sleep in the OSAHS group. There is not difference between the hypertensive patients with or without OSAHS in NO levels.