阻塞性睡眠呼吸暂停综合征患者晨间血压升高的影响因素

Clinical analysis of the rise of morning blood pressure in the patients with obstructive sleep apnea syndrome

目的 探讨影响阻塞性睡眠呼吸暂停综合征 (OSAS)患者晨间血压升高的危险因素。方法 对 14 8例确诊的OSAS患者晨间血压变化与临床资料和多导睡眠图 (PSG)监测指标之间的关系进行分析。晨间收缩压≥晚间收缩压 10mmHg或 (和 )晨间舒张压≥晚间舒张压 10mmHg者被认为有晨间血压升高。以有或无晨间血压升高作为依据 ,将OSAS患者分为两组。比较两组OSAS患者的年龄、身高、体重、颈围、腹围、有无高血压病家族史等临床资料以及呼吸紊乱指数 (RDI)、最低脉搏血氧饱和度 (SpO2 )值、SpO2 值低于 90 %时间占总睡眠时间百分比、最长呼吸暂停时间等PSG监测指标之间的区别 ,并进行Logistic回归分析。结果 在 14 8例OSAS患者中 ,有 76例出现晨间血压升高 ,72例无晨间血压升高。两组患者在年龄、体重、颈围、腹围、有无高血压病家族史以及RDI、最低SpO2 值、SpO2 值低于 90 %时间占总睡眠时间百分比、最长呼吸暂停时间方面的差别均有显著性意义 (P <0 0 5 )。多因素Lo gistic回归分析结果表明 ,年龄、RDI、最低SpO2 值和SpO2 值低于 90 %的时间占总睡眠时间百分比对OSAS患者晨间血压升高有显著性意义 ,其比值比 (OR)分别是 1 37( 95 %CI为 1 0 9～ 1 74 ,P =0 0 0 8) ;1 2 3( 95 %CI为 1 0 7～1 4 3,P =0 0 0

Objective To investigate the factors responsible for the riseof morning blood pressure (BP) in the patients with obstructive sleep apnea syndrome (OSAS).Methods 148 consecutive OSAS patients were made a diagnosis with the polysomnogram (PSG).BP was measured in the evening before sleep and after sleep the following morning. The definition of morning rise in BP was that the patients′ morning systolic BP or diastolic BP was 10mmHg higher than that of the evening SBP or DBP respectively. The rising group of the morning BP was compared with the non-rising group of the morning BP in the data, which included age, height, weight, neck collar, abdomen circumference, the family history of hypertension, respiratory disturbance index (RDI),oxygen saturation (SpO 2) nadir, the percentage of the period with SpO 2 less than 90% in total sleep time, the longest apnea time. Multiple factor Logistic regression analysis was undertook for above data.Results Of the 148 patients,76 cases showed the morning rise in BP.The rising group of morning BP had statistical significance with the non-rising group of morning BP in above index except for body height.Multiple factor Logistic regression analysis revealed that age,RDI,SpO 2 nadir,the percentage of the period with SpO 2 less than 90% in total sleep time were associated with the presence of the morning rise in BP, while their odd ratios were 1 37(95%CI 1 09～1 74,P=0 008);1 23(95% CI 1 07～1 43,P=0 004);1 35(95%CI 1 03～1 78,P=0 031);1 21(95% CI 1 04～1 39,P=0 008) respectively.Conclusion Age,RDI,SpO 2 nadir and the percentage of the period with SpO 2 less than 90% in total sleep time were the independent factor for morning rise in BP with OSAS patients. The age and the severity of OSAS could be responsible for the morning rise in BP.