睡眠呼吸暂停与睡前、醒后血压变化关系的初步研究

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）在高血压病发病中的作用。方法纳入2003年9月-2007年9月在呼吸睡眠监测中心就诊、Epworth嗜睡量表评分〉9分的成年患者，进行多导睡眠图（PSG）和血压检测，根据睡眠呼吸暂停低通气指数（AHI）将所有对象分为4组，比较各组患者睡前与醒后的血压变化，了解血压变化与PSG的各项指标的相互关系。结果共1528例患者入选。非OSAHS组患者（AHI〈5次／h，n=172）的睡前、醒后血压无显著差异（P〉0．05）；轻度OSAHS组患者（AHI≤20次／h，n=435）的舒张压升高1．73mmHg；中度OSAHS组患者（AHI≤40次／h，n=307）的收缩压和舒张压分别升高3．52mmHg和3．71mmHg；重度OSAHS组患者（AHI〉40次／h，n=614）的收缩压和舒张压分别升高3．72mmHg和4．22mmHg。轻度OSAHS组患者夜间收缩压的变化与微觉醒指数呈显著正相关（r=0．25，P〈0．05）。中度OSAHS组患者夜间收缩压的变化与体重指数（BMI）呈显著正相关（r=0．25，P〈0．05）。重度OSAHS组患者夜间收缩压的变化与BMI、最长呼吸暂停时间呈正相关（r值分别为0．26和0．25，P均〈0．05）；夜间舒张压的变化与AHI、平均呼吸暂停时间（MA）呈正相关（r值分别为0．22和0．17，P均〈0．05）；夜间平均血压的变化与AHI和MA呈正相关（r值分别为0．25和0．20，P〈0．05）。结论OSAHS可引起夜间血压升高，但幅度不大；影响血压的因素因OSAHS的严重程度不同而各异。

Initial research on correlations between blood pressure variations and obstructive sleep apnea hypopnea syndrome

Objective To explore the contribution of obstructive sleep apnea hypopnea syndrome （OSAHS） in the variations of blood pressure in the evening to morning and possible mechanisms. Methods In Sleep and Breathing Disorders Centre, from September 2003 to September 2007, adult patients whose Epworth sleeping score 〉 9 were undergone polysomnography（PSG） and divided into 4 groups according to apnea hyponea index（AHI）. The levels of blood pressure were monitored and compared between evening and morning. Correlations between PSG indexes and variations of the systolic blood pressure （SBP） and diastolic blood pressure（DBP） were analyzed in OSAHS patients. Results 1 528 patients were enrolled in this study. There was no significant difference between the evening and morning blood pressure in the non- OSAHS group（AHI 〈 5, n = 172）,whereas DBP rised about 1.73 mm Hg in the mild OSAHS group （AHI≤20,n = 435）, SBP and DBP rised about 3.52 and 3.71 mm Hg respectively in the moderate OSAHS group（ AHI≤40 ,n = 307）, and SBP and DBP rised about 3.72 and 4.22 mm Hg respectively in the severe OSAHS group （AHI 〉 40, n=614）. The variation of SBP during the night correlated positively with the arousal index in the mild OSAHS group （ r = 0. 25, P 〈 0. 05 ） , but with the body mass index （BMI） in the moderate OSAHS group （ r = 0. 25, P 〈 0. 05 ）. In the severe OSAHS group, the variation of SBP during the night correlated positively with BMI and the longest apnea time （LA） （r=0.26,0.25, both P 〈0.05） ,the variation of DBP during the night correlated positively with AHI and mean apnea duration（MA） （ r = 0.22,0.17, both P 〈 0. 05 ）, and the variation of mean arterial pressure during the night correlated positively with AHI and MA （r=0.25,0.20, both P 〈0.05 ）. Conclusions OSAHS may induce mild rises of the blood pressure at night. The relevant factors that influence the blood pressure are different in different severity of the OSAHS.