阻塞性睡眠呼吸暂停患者睡眠时相与血压及心率之间的关系

目的明确睡眠时相对阻塞性睡眠呼吸暂停综合征（OSAS）患者血压和心率的特异性影响及两者之间关系。方法13例OSAS患者在桡动脉内留置导管监测血压并同步进行夜间睡眠多导生理仪连续记录。、结果（1）以清醒期血压作基准，OSAS患者快动眼睡眠（REM）期暂停发生前、终止后收缩压及暂停终止后舒张压的增高幅度分别为（-1.9±11.9）mmHg、（32.6±20.6）mHg、（18.2±11.6）mmHg，明显高于非快动眼睡眠（NREM）期分别为（-8.4±8.0）mmHg，（20.4±6.9）mmHg，（13.2±5.8）mmHg，P均＜0.05;（2）OSAS患者NREM期暂停后心率（76±8）次／分较暂停前（70±8）次／分明显增快，P＜0.05;REM期暂停后心率（85±11）次／分较暂停前（71±8）次／分明显增快，P＜0.01;暂停后心率REM期较NREM期明显增快，P＜0.01;暂停前后心率变化幅度REM期（14.1±10.1）次／分，明显高于MREM期（6.9±2.2）次／分，P＜0.05;（3）OSAS患者NREM期暂停前后收缩压、舒张压增高幅度与暂停前心率明显相关（r=-0.699，P＜0,01;r＝-0.602，P＜0.05）;NREM期暂停前后收缩压增高幅度与暂停后心率明显相关（r=-0.669，P＜0.01）。结论OSAS患者睡眠时相对血压及心率变化有影响;OSAS患者夜间呼吸暂停时血压变化与心率有关。

Effects of sleep stage on blood pressure and heart rate in patients with obstructive sleep apnea syndrome

OBJECTIVE: To determine the effects of sleep stage on blood pressure(BP) and heart rate(HR) and to explore the relationship between BP and HR in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Manometric tube was retained in the radial artery, and whole-night polysomnography (PSG) was done synchronously in 13 patients with OSAS. RESULTS: (1) The increase in BP during apnea was higher in REM sleep than in NREM sleep, but the difference was not significant (P > 0.05). When BP in awake state was regared as baseline, the increases in SBP pre-apnea and post-apnea and the increases in DBP post-apnea were significantly higher in REM sleep(-1.9 +/- 11.9 mm Hg, 32.6 +/- 20.6 mm Hg, 18.2 +/- 11.6 mm Hg, respectively) than in NREM sleep (-8.4 +/- 8.0 mm Hg, 20.4 +/- 6.9 mm Hg, 13.2 +/- 5.8 mm Hg, P < 0.05, respectively). (2) In different sleep stages, HR was markedly higher at the end of apnea than before apnea(NREM: 76 +/- 8 bpm vs 70 +/- 8 bpm, P < 0.05; REM: 85 +/- 11 bpm vs 71 +/- 8 bpm, P < 0.01). HR in post-apnea (P < 0.01) and the increase in HR during apnea (NREM: 6.9 +/- 2.2 bpm, REM: 14.1 +/- 10.1 bpm, P < 0.05) were remarkably higher in REM sleep than in NREM sleep, but not for pre-apneic HR. (3) In NREM sleep, HR in pre-apnea was significantly correlated with the increase in SBP and DBP during apnea(r = -0.699, P < 0.01; r = -0.602, P < 0.05, respectively); The increase in SBP during apnea in NREM sleep was also correlated with post-apnea HR (r = -0.669, P < 0.01). CONCLUSION: Sleep stage has effects on BP and HR and the changes in BP are correlated with the changes in HR during apnea in patients with OSAS.