呼吸睡觉障碍对老年人动态血压影响的临床观察

目的探讨老年睡眠呼吸障碍(SAS)患者24 h动态血压变化特点及可能的发病机制。方法对2005—2006年在我科住院诊治的患者进行问卷调查,患者配戴手握式脉搏血氧仪及24 h动态血压监测,选择老年SAS合并原发性高血压患者组30例、单纯SAS患者血压正常组30例、无SAS的高血压患者组20例为研究对象。结果三组患者呼吸紊乱指数、最低血氧饱和度、氧减指数等指标差异有统计学意义(均P<0.05);平均收缩压、平均舒张压三组患者比较差异有统计学意义(均P<0.05);睡前、晨起收缩压、舒张压三组比较差异有统计学意义(均P<0.05);SAS合并原发性高血压组晨起血压较睡前血压明显增高(均P<0.05)。结论睡眠呼吸紊乱和低氧血症是引起SAS患者高血压形成的重要因素,SAS合并原发性高血压患者血压整体水平较高,晨起舒张压升高尤为明显。

Clinical observation on relation between obstructive sleep apnea syndrome and hypertension in the elderly

Objective To analyze the dynamic change of blood pressure in 24 hours in elderly patients with obstructive sleep apnea syndrome(SAS) and its possible pathogenesis.Methods Questionnaire surveys were conducted to the patients who were treated in our hospital from 2005 to 2006.Thirty patients with SAS and essential hypertension and 30 cases with SAS confirmed by polysomnography(PSG) were monitored ambulatory blood pressure in 24 hours.Twenty hypertensive patients without SAS were used as control.Results There were statistical difference in apnea hyponea index,minimum saturation of blood oxygen and oxygen desaturation index in the cases with SAS and hypertension group compared with that of only SAS group(P<0.05).There were significant difference in average systolic pressure and diastolic pressure(SBP and DBP)(P<0.05),and before sleeping in the night and just after waking in the morning among three groups(P<0.05).The blood pressure was significantly higher just after waking in the morning than that before sleeping in the night in patients with SAS and hypertension(P<0.05).Conclusion Sleep-related breathing disorders and hypoxemia are important factors which lead to hypertension in patients with SAS.The total levels of blood pressure,especially the diastolic pressure of just after waking in the morning,are much higher in patients with SAS and essential hypertension.