呼吸干预在高血压合并阻塞性睡眠呼吸暂停低通气综合征治疗中的作用

目的 了解呼吸干预在高血压合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗中的作用.方法 采用回顾性研究方法,分析2012年4月至2013年5月在北京大学人民医院住院的高血压合并OSAHS患者383例的病历资料,根据是否使用持续正压通气（CPAP）治疗将上述高血压合并OSAHS患者分为2组,CPAP治疗组（144例）及未经CPAP治疗的对照组（239例）.对这些患者的临床特点、性别年龄分布及呼吸干预治疗情况进行分析.结果 383例高血压合并OSAHS患者高血压的发病年龄低于普通人群,45岁以下诊断高血压病者达52.9％（203/383）;所有患者中男306例,女77例,男女比例为3.97∶1.CPAP治疗组的患者治疗后收缩压、舒张压、体重指数明显下降,与对照组比较差异有统计学意义（130.0±7.6）mmHg（1 mmHg=0.133 kPa）比（150.0±12.2） mmHg、（85.0±2.1）mmHg比（93.0±2.3） mmHg、（24.8 ±2.6） kg/m^2比（26.9±2.7） kg/m^2] （P＜0.05）.睡眠呼吸暂停低通气指数、夜间最低血氧饱和度也较治疗前有明显改善（3.5±1.2）比（48.5±10.6）、（89.5±5.2）％比（75.1±8.5）％]（P＜0.01）;部分患者降压药物减量或停用,仅用CPAP治疗就能维持正常血压.结论 睡眠呼吸暂停相关性高血压患者高血压的发病年龄趋于年轻.患者经CPAP治疗后,不但可改善睡眠呼吸障碍,还可以有效控制血压,提示对于高血压患者来说进行OSAHS的筛查十分必要,而CPAP的治疗对高血压合并OSAHS患者是一种行之有效的抗高血压治疗.

Efficacy of respiratory intervention on patients with hypertension complicated with obstructive sleep apnea-hypopnea syndrome

Objective To analyze clinical characteristics,sex and age distributions,and treatment of hypertensive patients related obstructive sleep apnea syndrome （OSAHS）,to understand the importance of respiratory intervention eombined with OSAHS in the treatment of hypertension.Methods Retrospective study was used to analyze 587 inpatients who were diagnosed with sleep apnea syndrome combined,among these patients,383 with hypertension in our hospital from April 2012 to May 2013.And 144 patients received at least 3 months continuous positive airway pressure （CPAP） therapy.The study aims to analyze the clinical characteristics,sex and age distributions,and respiratory intervention respiratory intervention treatment status of these patients.Results Among the 383 sleep apnea syndrome related hypertensive patients,patients developed hypertension younger than the general population and the patients younger than 45 years old with diagnosis of hypertension accounted for 52.9%.There were 306 males and 77 females among all patients with the ratio of 3.91 to 1.After CPAP treatment,the systolic blood pressures,diastolic blood pressures,BMI were significantly decreased （130.0 ± 7.6） mmHg vs （150.0 ± 12.2）mmHg,（85.0±2.l）mmHg vs （93.0 ±2.3）mmHg,（24.8 ±2.6）kg/m^2 vs （26.9±2.7） kg/m^2] （P〈 0.05）.Sleep apnea hypopnea index and night minimum oxygen saturation were significantly improved （3.5 ± 1.2） vs （48.5±10.6）,（89.5 ±5.2）% vs （75.1 ±8.5）%] （P〈0.01）.Some of the patients reduced or stopped antihypertensive medications and only used CPAP to keep the normal blood pressure.Conclusions Sleep apnea syndrome related hypertensive patients the age of onset developed hypertension with young tendency.After CPAP treatment,the sleep respiratory disorder is greatly improved and blood pressure is well controlled,indicating that the screening for OSAHS is essential for hypertensive patients.CPAP treatment is an effective antihypertensive treatment for the hypertension combined with OSAHS patients.