微觉醒与低氧对阻塞性睡眠呼吸暂停综合征合并高血压患者昼夜血压的影响

目的　研究睡眠过程中反复发生的微觉醒与低氧是否影响阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压患者的昼夜血压水平。方法　 6 0例OSAS患者根据门诊血压、2 4h动态血压和多导睡眠图监测结果分为OSAS合并高血压组 (OSAS +HT组 ,30例 )与单纯OSAS组 (OSAS组 ,30例 )。测定运动微觉醒指数 (MAI)、皮质微觉醒指数 (CAI)、呼吸暂停低通气指数 (AHI)、血氧饱和度低于90 %的时间 (OLT90 %)和 2 4h平均收缩压 (ASBP)与舒张压 (ADBP)。以OSAS +HT组 2 4h平均收缩压与舒张压分别与MAI、CAI、AHI、OLT90 %、体重指数和年龄作多元逐步回归分析。结果　影响OSAS +HT组 2 4h收缩压与舒张压的第一重要因素是MAI(ASBP :r =0 485 ,P <0 0 1;ADBP :r =0 40 7,P <0 0 5 ) ,第二重要因素 :OLT90 %(ASBP :r=0 382 ,P <0 0 5 ;ADBP :r=0 36 9,P <0 0 5 )。结论　反复发生于呼吸暂停终末的运动微觉醒与低氧是影响OSAS合并高血压患者昼夜血压水平的重要因素 ,它们可能是参与OSAS患者长期高血压形成的重要因素。

Effect of movement arousal and hypoxia on circardian blood pressure in hypertensive patients with obstructive sleep apnea syndrome

Objective To investigate whether repeated arousals and hypoxia at the end of apnea contribute to nocturnaland diurnal elevation of blood pressure in obstructive sleep apnea syndrome(OSAS)patients with hypertension.Methods 30 OSAS patients with hypertension and 30 OSAS patients without hypertension were studied.Movement arousal index(MAI),cortical arousal index(CAI),length of time during which nocturnal oxygen saturation decreased below 90%(OLT90%),apnea/hypopnea index(AHI),24 h average systolic and diastolic blood pressure(ASBP and ADBP) were measured.Multiple stepwise regression analysis was performed to find the correlation between 24 h ASBP ,ADBP and MAI,CAI,OLT90%,AHI,age,body mass index in OSAS patients with hypertension.Results MAI made the most significant contribution to 24 h ASBP and ADBP in OSAS patients with hypertension (ASBP:r=0.485,P<0.01; ADBP: r=0.407,P<0.05).OLT90% was the second most important contributing factor(ASBP:r=0.382,P<0.05;ADBP:r=0.369,P<0.05). Conclusion Movement arousal and hypoxia may make an important contribution to circardian elevation of blood pressure in OSAS patients with hypertension.Both of them may contribute to the development of nocturnal and diurnal hypertension in patients with OSAS.