Obstructive Sleep Apnea and Hypertension

Obstructive sleep apnea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure. However, these studies do indicate a wide variation in the blood pressure effects of CPAP, with some patients, on an individual basis, manifesting a large antihypertensive benefit. OSA is particularly common in patients with resistant hypertension. The reason for this high prevalence of OSA is not fully explained, but data from our laboratory suggest that it may be related to the high occurrence of hyperaldosteronism in patients with resistant hypertension. We hypothesize that aldosterone excess worsens OSA by promoting accumulation of fluid in the neck, which then contributes to increased upper airway resistance.     

高血压患者阻塞性睡眠呼吸暂停综合征的临床观察

目的:通过观察高血压患者的阻塞性睡眠呼吸暂停综合征(OSAS)的临床表现,旨在探讨不同体重对OSAS的影响。方法:选择269例有打鼾史的高血压患者,进行夜间多导联睡眠图监测。根据体重指数(BMI)分成3组:正常体重组40例,年龄(51.8±11.3)岁,体重指数(23.3±1.0)kg/m2;超重组77例,年龄(49.5±10.2)岁,体重指数(26.0±0.8)kg/m2;肥胖组152例,年龄(46.2±9.8)岁,体重指数(30.6±2.7)kg/m2。所有患者均测量身高、体重、腰围、血压、血脂、空腹血糖、空腹胰岛素、血肌酐,进行各组间各变量比较分析。结果:①269例打鼾的高血压患者中,82.5%(222例)表现为OSAS,单纯鼾症者占17.5%(47例);OSAS患者中男性占80.2%(178例),体重正常者占14.9%(33例),超重者占26.6%(59例),肥胖者占58.6%(130例)。②3组中OSAS严重程度分布不均,正常体重组主要为轻度OSAS(40%),超重组主要为中度OSAS(37.7%),肥胖组主要为重度OSAS(32.9%),差异有统计学意义(P0.05)。③肥胖组的舒张压、腰围、体重指数、睡眠呼吸暂停低通气指数(AHI)均明显高于正常体重组和超重组,年龄、最低氧饱和度均明显低于正常体重组和超重组,高密度脂蛋白胆固醇明显低于正常体重组,差异均有统计学意义(P0.05～0.01)。④多元回归分析表明:收缩压或舒张压均与AHI和腰围呈正相关。AHI与腰围、稳态模式评估法的胰岛素抵抗指数(HOMA-IR)呈正相关;最低氧饱和度与腰围、HOMA-IR呈负相关。结论:肥胖是高血压独立危险因素,也是OSAS发病的重要原因之一。体重越重,OSAS的严重程度越明显。     

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.     

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。     

阻塞性睡眠呼吸暂停低通气综合征与高血压关系的研究进展

睡眠呼吸暂停综合征是一种睡眠时呼吸停止的睡眠障碍.最常见的原因是上呼吸道阻塞,经常以大声打鼾、身体抽动或手臂甩动结束,主要以睡眠中反复发作的呼吸暂停或低通气导致的低氧血症及高碳酸血症为特点.主要分为中枢型、阻塞型及混合型,其中以阻塞性睡眠呼吸暂停综合征(OSAS)最为常见,是多种全身性疾病的危险因素,肥胖、年纪大、肌肉松弛的人群高发.多导睡眠图(PSG)是诊断此病的金标准,量化指标是呼吸暂停低通气指数(AHI)及夜间最低血氧饱和度.研究表明,OSAS常与高血压、冠心病、脑卒中等疾病并存[1],这一现象受到越来越多的心脑血管专家的关注.值得指出的是,流行病学及临床研究证实OSAS与高血压之间存在密切因果关系[2-4].本文主要就阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压的关系进行综述.     

伴及不伴OSA高血压患者超敏C反应蛋白和OSA的相关性研究

目的研究伴及不伴睡眠呼吸暂停(obstructive sleep apnea,OSA)高血压患者的超敏C反应蛋白(high-sensitivity C-reactive pro-tein,hs-CRP)和睡眠呼吸暂停低通气指数(apnea hyperpnoea index,AHI)的相关性,揭示此类疾病与炎症反应的关系,为中西医诊治提供一定的临床研究依据。方法纳入阴虚阳亢型轻中度高血压患者96例,对患者行便携式睡眠仪监测、24h动态血压(AB-PM)监测及hs-CRP检测。采用直线回归和多元逐步回归法分析OSA和hs-CRP及血压的关系。结果与不伴OSA患者相比,伴OSA的轻中度高血压患者的hs-CRP水平明显增高(P<0.05),并且hs-CRP和AHI呈正相关。结论 hs-CRP这一炎症因子参与了伴OSA的轻中度高血压患者的疾病过程,并且与OSA的病情严重程度相关。     

阻塞性睡眠呼吸暂停的治疗进展

谈阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）的治疗,首先需要明确的是OSA治疗的目的。OSA是多种原因造成睡眠中上气道不同程度的狭窄或阻塞,而引发的以睡眠打鼾、呼吸暂停和日间嗜睡等症状为主的一个综合征。问题发生在上气道,引发的合并症确遍及全身,对机体的损害涉及心脑血管、呼吸、消化、血液、泌尿生殖和代谢等多个系统。     

The Relationship between Morning Hypertension and Sleep Quality in Patients with Obstructive Sleep Apnea Syndrome

This study aimed to investigate the prevalence of abnormal diurnal blood pressure (BP) profiles in patients with obstructive sleep apnea syndrome (OSAS) in relation to the data of a sleep study. Total 103 patients newly diagnosed with OSAS underwent overnight polysomnography and 24-hour ambulatory BP measurements. Patients without morning or nocturnal hypertension (control group), patients with morning hypertension but not nocturnal hypertension (surge-type group), and patients with both morning and nocturnal hypertension (sustained-type group) were compared. Morning hypertension was present in 54 patients (16 surge-type and 38 sustained-type). The apnea–hypopnea index and sleep efficiency were higher and lower, respectively, in the sustained-type group than in the other groups. Slow-wave sleep incidence was significantly lower in the sustained-type and surge-type groups than in the control group. These results suggest that approximately half the OSAS patients displayed morning hypertension, the sustained-type being more common than the surge-type. Poor sleep quality plays an important role in the pathogenesis of morning hypertension in both the sustained- and the surge-type group.     

阻塞性睡眠呼吸暂停低通气综合征与高血压的研究进展

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyponea syndrome,OSAHS）是指在睡眠过程中上呼吸道塌陷阻塞引起的呼吸暂停和通气不足,伴有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降及白天嗜睡等病理综合征。OSAHS与高血压病关系密切,OSAHS是高血压独立危险因素之一,可通过导致血管内皮功能障碍,激活交感神经系统和肾素一血管紧张素一醛固酮系统,促进脂质代谢障碍及增加氧化应激等途径介导高血压病的发生、发展。现就目前OSAHS与高血压研究新进展做一综述。     

Cardiovascular Implications in the Treatment of Obstructive Sleep Apnea

Epidemiological studies provide strong evidence that obstructive sleep apnea (OSA) is associated with cardiovascular complications such as systemic hypertension, congestive heart failure, and atrial fibrillation. Successful OSA treatment with continuous positive airway pressure (CPAP) has resulted in coincident reductions in systemic hypertension, improvements in left ventricular systolic function, and reductions in sympathetic nervous activity. These data suggest that successful treatment of OSA may reduce cardiovascular morbidity in such patients. Although CPAP is the more successful treatment for OSA when used properly and consistently, its clinical success is often limited by poor patient and partner acceptance, which leads to suboptimal compliance. Oral appliances or upper airway surgeries are considered a second line of treatment for patients with mild to moderate OSA who do not comply with or refuse long-term CPAP treatment. Oral devices such as mandibular repositioning appliances were recently shown to improve arterial hypertension in OSA patients. Electrical stimulation of the hypoglossal nerve is a new investigational therapy for patients with moderate to severe OSA. This new treatment option, if proven effective, may provide cardiovascular benefits secondary to treating OSA.     

阻塞性睡眠呼吸暂停与心血管疾病的关系及发病机制探讨

阻塞性睡眠呼吸暂停的发病率有逐年增高趋势,越来越多的研究表明阻塞性睡眠呼吸暂停与心血管疾病（如高血压、肺动脉高压、冠心病、心律失常、心力衰竭等）的发生率与病死率关系密切;为有助于加深心血管病医生对阻塞性睡眠呼吸暂停与心血管疾病的认识,进一步探索阻塞性睡眠呼吸暂停的发病机制,从而提高疾病的防控水平;现就阻塞性睡眠呼吸暂停与心血管病的关系,导致疾病的可能发病机制作一综述。