Do Autonomic Cardiovascular Reflexes Predict the Nocturnal Rise in Blood Pressure in Obstructive Sleep Apnea Syndrome?

To investigate the relationship between nocturnal changes in blood pressure (BP) and diurnal cardiovascular reflexes we examined a group of 19 male normotensive obstructive sleep apnea syndrome (OSAS) patients. All patients underwent a full polysomnographic examination including BP monitoring by a finger arterial pressure device (Finapres) and a battery of cardiovascular reflex tests; plasma catecholamine levels at rest were also measured. During sleep, BP increased with an average difference of 15.4 ± 7.5 mmHg for systolic and 8.3 ± 4.6 mmHg for diastolic pressure. Compared with control subjects, OSAS patients had lower values of Valsalva ratio (VR) (1.75 ± 0.4 vs 1.34 ± 0.2, p = 0.0004), E/I ratio (1.35 ± 0.2 vs 1.13 ± 0.9, p = 0.0004) and baroreflex sensitivity index (BRSI) (5.4 ± 2.1 vs 2.7 ± 1.9 mms/mmg, p = 0.0006) and a higher systolic (p = 0.02) and diastolic (p = 0.002) pressure response to tilting-up test. Noradrenaline plasma levels were also significantly higher (345 ± 125 vs 224 ± 92 pg/ml, p = 0.001). No significant correlations were found between the nocturnal rise in BP and the pressure responses during sympathetic manoeuvres or rest levels of noradrenaline. The nocturnal changes in systolic blood pressure during the night were negatively dependent on the diurnal BRSI (r = --0.91, p = 0.0007) and VR (r = --0.70, p = 0.006). We conclude that the high levels of noradrenaline at rest and the altered sympathetic cardiovascular reflexes alone do not account for the nocturnal variation in blood pressure in OSAS. Reduced baroreflex sensitivity and apnea-related vagal impairment appear to be implicated in the nocturnal pressure response to obstructive apneas.     

高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

目的探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化。方法入选高血压患者105例,根据多导睡眠仪监测结果分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组36例和高血压合并中、重度 OSAS 组22例。CPAP 或手术治疗前后行24 h 动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系。结果治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%。与单纯高血压组比较,差异有统计学意义(P<0.05)。治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%,38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05)。中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显。结论高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与 OSAS 严重性相关,CPAP 或手术治疗后非杓型明显减少。     

高血压合并阻塞性睡眠呼吸暂停低通气综合征患者短时血压变异性的影响因素研究

目的:探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者短时血压变异性(BPV)的影响因素。方法:选择2017年6月至2019年5月在宁波市第一医院心血管科诊治的153例高血压患者,给予多导睡眠呼吸监测及动态血压监测,根据睡眠呼吸暂停低通气指数(AHI)将患者分四组:单纯高血压作为对照组(41例)、高血压合并轻度OSAS组(36例)、高血压合并中度OSAS组(36例)、高血压合并重度OSAS组(40例)。采用因子分析方法提取影响高血压合并OSAS患者短时血压变异性的公因子,进行多元线性回归分析影响高血压合并OSAS患者短时血压变异性的因素。结果:因子分析纳入可能影响高血压合并OSAS患者短时血压变异性的因素,共提取4个公因子:体重指数、OSAS严重程度相关参数、生活行为习惯、年龄及高血压病程;多元线性回归分析显示OSAS严重程度与高血压合并OSAS患者夜间收缩压短时血压变异性(nSBPARV)及夜间舒张压短时血压变异性(nDBPARV)均存在相关性(β=0.277,P<0.05;β=0.360,P<0.05),对于高血压合并OSAS患者nSBPARV的影响因素依次为OSAS严重程度>年龄及高血压病程(分别为β=0.277,P<0.05;β=0.225,P<0.05),对于nDBPARV的影响因素依次为OSAS严重程度>体重指数(分别为β=0.360,P<0.05;β=0.187,P<0.05)。高血压合并轻度、中度、重度OSAS组的nSBPARV、nDBPARV均较对照组大;且高血压合并重度OSAS组的nSBPARV、nDBPARV、日间收缩压短时血压变异性均大于对照组、高血压合并轻度、中度OSAS组,差异均具有统计学意义(P<0.05)。结论:高血压患者合并OSAS时容易出现夜间短时血压变异性增加,OSAS严重程度是高血压合并OSAS患者夜间血压短时变异性增加的主要因素,肥胖、年龄及高血压病程也是重要影响因素。     

伴及不伴OSA高血压患者的血压变异性和OSA相关性研究

目的研究伴或不伴睡眠呼吸暂停(obstructive sleep apnea,OSA)高血压患者的血压变异性和OSA的相关性。方法纳入阴虚阳亢型轻中度高血压患者90例,对患者行便携式睡眠仪监测、24h动态血压(ABPM)监测。观察患者血压的均值、变异性,及昼夜节律和OSA的关系;采用多元逐步回归法分析OSA和血压的关系。结果与不伴OSA的高血压患者相比,伴OSA患者的血压变异性和非杓型血压发生率明显增高,夜间血压下降率明显降低(P<0.05);其中夜间平均收缩压、24h收缩压血压标准差与睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)呈正相关,夜间收缩压下降率和AHI呈负相关(P<0.05)。结论伴OSA患者的血压变异性增高,昼夜节律紊乱。     

阻塞性睡眠呼吸暂停对血压的影响

目的:探讨阻塞性睡眠呼吸暂停(OSA)对血压的复杂调节作用.方法:对2008-05至2009-05在本中心就诊的患者行整夜多导睡眠监测和晨起血压测量,根据呼吸暂停低通气指数(AHI)和最低血氧饱和度筛选共277例患者入选.对照组26例(AHI<5),单纯OSA组115例分为轻度亚组(5≤AHI<20)37例、中度亚组(20≤AHI<40)29例、重Ⅰ度亚组(40≤AHI<60)24例、重Ⅱ度亚组(AHI≥60)25例共4个亚组;OSA合并高血压病组136例,按单纯OSA组AHI标准分为轻度亚组27例、中度亚组20例、重Ⅰ度亚组33例、重Ⅱ度亚组56例共4个亚组.结果:与对照组比较,单纯OSA组和OSA合并高血压病组体重指数、AHI、最长呼吸暂停时间、氧饱和度低于90%的时间百分比、微觉醒指数、舒张压和平均动脉压均增加,最低血氧饱和度、平均血氧饱和度均降低,差异均有统计学意义(P均<0.05).单纯OSA组中度、重Ⅰ度、重Ⅱ度三亚组舒张压较轻度亚组升高,差异均有统计学意义(P均<0.05).OSA合并高血压病组中度、重Ⅱ度二亚组较轻度亚组收缩压和舒张压升高,差异均有统计学意义(P均<0.05);OSA合并高血压病组平均动脉压中度亚组较轻度亚组升高,重Ⅰ度、重Ⅱ度二亚组较中度亚组降低,差异均有统计学意义(P均<0.05).单纯OSA组轻度亚组舒张压与AHI呈正相关(r=0.69,P＜0.05);重Ⅱ度亚组平均动脉压与最低血氧饱和度呈负相关(r=-0.60,P＜0.05).OSA合并高血压病组轻度亚组收缩压与最长呼吸暂停时间呈正相关(r=0.60,P＜0.05);中度亚组收缩压与最长呼吸暂停时间呈正相关(r=0.73,P＜0.05),舒张压、平均动脉压与AHI呈正相关(r分别为0.88和0.86,P＜0.05);重Ⅰ度亚组舒张压、平均动脉压与AHI呈负相关(r分别为-0.58和-0.70,P＜0.05),舒张压与最低血氧饱和度呈正相关(r=0.47,P＜0.05).结论:OSA对血压的影响情况因病情程度不同而异.     

Obstructive Sleep Apnea and Blood Pressure Elevation: What is the Relationship?

Sleep disordered breathing has increasingly been recognised as a frequent cause of ill-health in the community. Moderate or severe forms of the most common condition, obstructive sleep apnea (OSA), occur in up to 12% of the adult male population. A substantial body of literature has been published on the potential relationship between OSA and cardiovascular disease. In particular, OSA has been associated with cardiac failure, stroke, myocardial infarction and hypertension. Part of this association may be explained by other confounders, mainly obesity, which is common in OSA patients. The present review was prepared following a workshop aimed to critically review available scientific evidence suggesting that hypertension is a direct consequence of OSA. In addition, pathophysiologic mechanisms that may be involved in the relationship between OSA and cardiovascular disease, particularly brief intermittent elevation of blood pressure and sustained systemic hypertension, are discussed.     

阻塞性睡眠呼吸暂停综合征合并2型糖尿病血糖管理

目的探讨阻塞性睡眠呼吸暂停综合征合并2型糖尿病患者的降糖方案。方法 51例阻塞性睡眠呼吸暂停综合征合并2型糖尿病患者随机分为A组和B组。A组使用预混胰岛素治疗,B组在A组方案基础上加用艾塞那肽治疗,随访4个月,比较两组患者血糖控制、胰岛素抵抗指数、胰岛β细胞功能以及血脂、呼吸功能等变化情况。结果两组患者血糖均得到良好控制,B组患者BMI、TG、HOMA-IR较A组低;HOMA-β、FC-P较A组高。另外,两组呼吸功能均有改善,B组AHI、ESS评分低于A组;SPO2、最低SPO2较A组高。结论 OSAS合并2型糖尿病患者采用艾塞那肽联合胰岛素治疗可以安全有效控制血糖,调节血脂,改善胰岛素抵抗,进而改善低氧血症。     

Determinants of Daytime Blood Pressure in Relation to Obstructive Sleep Apnea in Men

This study investigated the roles of different potential pathophysiological mechanisms in the determination of blood pressure in relation to obstructive sleep apnea. The study was designed as a cross-sectional study. Consecutive healthy male subjects who were to undergo polysomnography were recruited. Demographic and anthropometric data were collected. Blood pressure measurements were taken in the evening before sleep and the next morning on waking. Overnight urinary samples for catecholamines and fasting blood for cortisol, insulin, glucose, and lipids were taken. Ninety-four men were analyzed, with a mean age of 43.7 ± 9.3 years and mean apnea–hypopnea index (AHI) of 27.5 ± 26.2 events/h. Sixty-nine patients (73%) had obstructive sleep apnea (AHI ≥ 5). Urinary catecholamines were positively correlated with severity of sleep apnea, independent of obesity. Blood pressure measurements correlated with age, obesity, severity of sleep apnea, and urinary catecholamines. Regression analysis showed that sleep indices and urinary catecholamines were independent determinants of morning systolic and diastolic blood pressure, respectively, while total cholesterol and waist circumference were respective additional factors. Urinary catecholamines and waist circumference were determinants of evening blood pressure, with morning cortisol being an additional determinant for diastolic blood pressure. Obstructive sleep apnea and related sympathetic activity contributed significantly to the determination of daytime blood pressure in overweight middle-aged men without overt cardiometabolic diseases, and other contributing factors include abdominal obesity, total cholesterol, and cortisol levels.     

儿童阻塞性睡眠呼吸暂停综合征与高血压的关系

目的探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)患者中高血压的患病情况。方法选取90例有睡眠打鼾的儿童,实施多导睡眠监测并同步进行24 h 动态血压监测。按呼吸暂停低通气指数(AHI)分为(OSAS 组(AHI≥5次/h)和对照组(AHI<5次/h),比较两组的临床血压指数值、高血压的发病率和非杓型血压的情况。结果 1)OSAS 组的体质量指数(BMI)、氧减指数(ODI)和睡眠期间血氧饱和度<92%的时间(TST92%)均比对照组高(P<0.05);2)OSAS 组夜间睡眠时的收缩压(SBP)和舒张压(DBP)指数,以及白昼的收缩压指数较对照组高(P<0.05);3)OSAS 组的高血压发病率及非杓型血压情况比对照组多(P<0.01)。结论儿童 OSAS 与高血压密切相关,且是高血压发病的危险因素,血压多呈非杓型改变。     

持续正压通气对合并阻塞性睡眠呼吸暂停低通气综合征的老年高血压患者血压的影响

目的 探讨持续正压通气对合并阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）的老年高血压患者血压的影响。方法 选择2015年6月至2018年1月就诊于我科,通过多导睡眠监测证实合并OSAHS的老年高血压患者126例,随机将其分为两组：对照组58例和治疗组68例,其中对照组给予常规降压药物,治疗组全部患者给予常规降压药物联合持续正压通气治疗,持续治疗6个月后,比较两组患者治疗前后24 h动态血压的变化。结果[结果部分应列举主要数据,并修改英文摘要] ①组间比较：治疗前两组患者的24 h平均收缩压（151.53±10.06,152.31±10.31）、24小时平均舒张压（69.81±9.89,69.51±9.57）、白天平均收缩压（160.62±10.39, 160.67±10.49）、白天平均舒张压（71.92±9.54,72.43±9.46）、夜间平均收缩压（147.72±11.21,146.57±11.09） 及夜间平均舒张压（67.38±10.88, 67.89±10.54 ）相比,未见统计学差异（P>0.05）,治疗后两组患者的24 h平均收缩压（140.63±8.33,136.50±9.02）、24小时平均舒张压（64.05±9.32,62.17±8.71）、白天平均收缩压（144.71±9.45,139.41±9.53）、白天平均舒张压（66.73±9.82,65.46±8.68）、夜间平均收缩压（137.65±10.34,131.36±10.35）及夜间平均舒张压（62.67±10.19,60.38±9.03）相比,治疗组明显低于对照组,差异具有统计学意义（P<0.05）。②组内比较：对照组与治疗组治疗前后的24 h平均收缩压（151.53±10.06与140.63±8.33,152.31±10.31与136.50±9.02）、24小时平均舒张压（69.81±9.89与64.05±9.32,69.51±9.57与62.17±8.71）、白天平均收缩压（160.62±10.3与9144.71±9.45,160.67±10.49与139.41±9.53）、白天平均舒张压（71.92±9.54与66.73±9.82,72.43±9.46与65.46±8.68）、夜间平均收缩压（147.72±11.21与137.65±10.34,146.57±11.09与131.36±10.35）及夜间平均舒张压（67.38±10.88与62.67±10.19,67.89±10.54与60.38±9.03）相比,治疗后较治疗前均下降,且差异具有统计学意义（P<0.05）,但治疗组各项血压观察指标下降幅度均高于对照组。结论 在常规药物基础上,联合持续正压通气治疗可更有效降低合并OSAHS的老年高血压患者的血压。     

高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

目的 探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化.方法 入选高血压患者105例,根据多导睡眠仪监测结果 分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS) 36例和高血压合并中、重度OSAS组22例.CPAP或手术治疗前后行24 h动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系.结果 治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%.与单纯高血压组比较,差异有统计学意义(P<0.05).治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%.38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05).中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显.结论 高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与OSAS严重性相关,CPAP或手术治疗后非杓型明显减少.     

持续正压通气对阻塞性睡眠呼吸暂停低通气患者血压影响差异分析

背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是高血压的独立危险因子,持续正压通气是其有效治疗方式。然而,持续正压通气(CPAP)对血压影响的结论并不统一。目的分析 CPAP 对 OSAHS 患者血压的影响。方法对2000-01—2008-01间 CPAP 对血压影响的论文进行检索,筛选经有效 CPAP 治疗不少于两周且治疗前后血压数据完整的随机试验,并对相关数据进行分析。结果经筛选,纳入相关文献16篇、共1309人。CPAP治疗组治疗前后收缩压降低5.4 mmHg(95%CI:2.9～7.8),舒张压降低3.9 mmHg(95%CI:1.9～5.9);持续正压通气后收缩压降低组与未降低组初始收缩压存在显著差异(144.5 mmHg vs 140.0 mmHg,P<0.05)。结论对于合并 OSAHS 的高血压患者,有效的 CPAP 治疗有利于控制血压,且初始血压高的 OSAHS 患者经有效 CPAP 后血压降低明显。但是,对血压的效益大小应根据初始血压情况、呼吸紊乱程度、嗜睡程度(ESS)进行综合评定。     

Obstructive Sleep Apnea Syndrome in Children

Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient. There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS. The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups. Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.     

睡眠呼吸暂停综合征与隐蔽性高血压

目的探讨睡眠呼吸暂停综合征(SAS)患者中隐蔽性高血压(MH)的患病情况。方法选取171例在华北煤炭医学院附属开滦医院睡眠监测室进行检查的偶测血压正常受试者,实施多导睡眠监测并同步进行24 h动态血压监测,次日晨起后采空腹肘静脉血行血生化检查。按睡眠呼吸暂停低通气指数(AHI)<5和 AHI≥5分为非 SAS 组和 SAS 组,比较两组 MH 的患病情况,并分析 SAS 组中 MH 和非 MH 的相关指标、MH 相关因素。结果1)SAS 组101例中有54例 MH 患者,患病率为53.5%,非 SAS 组70例中有14例 MH 患者,患病率为20%,差异有非常显著意义(P<0.01)。2)SAS 组中 MH 组与非 MH 组比较,年龄较轻;体质量指数较高;吸烟和饮酒者较多;日间平均心率较高;最长呼吸暂停持续时间较长;血氧饱和度较低,但差异均无统计学意义(P>0.05)。3)MH 相关因素单因素 logistic 回归分析显示:SAS、体质量指数、吸烟和饮酒是 MH 的危险因素。结论SAS 是 MH 的危险因素,且独立于体质量指数、吸烟和饮酒之外。     

阻塞性睡眠呼吸暂停低通气综合征患者自动正压通气治疗压力值的影响因素分析

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者自动正压通气(Auto-PAP)治疗压力值的相关影响因素,归纳压力预测值的回归函数.方法:选取于我院通过多导睡眠监测(PSG)符合OSAHS诊断并行自动压力滴定治疗的患者101例,回归性分析患者Auto-PAP滴定的90％治疗压力值(P90)与年龄、体重指数、颈...     

Relationship between Chemosensitivity, Obesity and Blood Pressure in Obstructive Sleep Apnoea

It has previously been documented that patients with obstructive sleep apnoea (OSA) have an abnormal blood pressure (pressor) response to acute hypoxia when awake. The relationship between hypoxic chemosensitivity and 24 h blood pressure in OSA is not known. Twenty-four hour ambulatory BP (ABP) was measured at 15 min intervals for 24 h using a non-invasive device (Oxford Medilog ABP or Spacelabs 90207 recorder) in 49 men (mean age 51 ± 9 years), with OSA. The BP response to acute hypoxia was measured either directly (radial arterial line) or indirectly (Finapress) during wakefulness. The pressor response to hypoxia (expressed as the slope of the regression line of mean BP on % fall in arterial oxygen saturation) was compared with the results of the ABP recording, sleep study data and clinical variables. A pressor response to acute hypoxia was present in all patients (mean 1.4 ± 1.1 mmHg/% δSaO₂, range 0.1-4.5). There was a relationship between the magnitude of the pressor response to hypoxia, severity of sleep apnoea (RDI and minimum SaO₂) and central obesity (waist measurement). In contrast, there was no relationship between BP response to hypoxia during wakefulness and 24-h BP. However, increasing obesity and severity of OSA were associated with loss of the normal fall in BP at night. We conclude that enhanced chemosensitivity is common in OSA but there is no demonstrable link between chemosensitivity and mean daytime or night-time ABP.