高血压合并阻塞性睡眠呼吸暂停综合征患者降压治疗后的动态血压监测

目的探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者降压治疗后血压的变化。方法选择降压治疗期间血压正常的70例高血压患者,其中单纯高血压组21例,合并OSAS组49例,选择健康对照13例。按睡眠呼吸暂紊乱指数将高血压合并OSAS患者分为轻度OSAS组22例,中度OSAS组15例,重度OSAS组12例。采用RS-611床垫式睡眠呼吸监测系统监测睡眠,并进行24 h动态血压监测。比较各组血压水平、昼夜血压节律、晨峰现象。结果在降压治疗期间,单纯高血压或者合并OSAS患者24 h动态血压控制在正常水平(<130/80 mmHg)。夜间血压下降率在单纯高血压组或者合并OSAS组均低于对照组(P<0.05或者P<0.01),合并OSAS组中、重度组下降率最低(P<0.05),合并OSAS组反杓型较单纯高血压组多(P<0.05),以重度OSAS组最多(P<0.05),晨峰现象不明显。结论老年高血压合并OSAS患者降压治疗后,白昼、夜间血压水平达标,但血压昼夜节律紊乱未能改善。

The antihypertension treatment in elderly hypertensive patients with obstructive sleep apnea syndrome

Objective To investigate the change of the antihypertension treatment in elderly hypertensive patients with obstructive sleep apnea syndrome（OSAS）.Methods 70 elderly patients with hypertension were divided into two groups,including 21 patients with simple hypertension and 49 patients with OSAS,which were further divided into three subgroups according to apnes-hypopnea index（AHI）,with 22 patients in mild OSAS subgroup,15 patients in moderate OSAS subgroup and 12 patients in severe OSAS subgroup.13 people without hypertension and OSAS were chosen as normal control.All the patients were monitored by RS-611 mattress monitoring system of sleep and their 24h ambulatory blood pressure were examined.The blood pressure level,the nighttime circadian rhythm and the phenomena of morning blood pressure surge were compared among all groups.Results During antihypertensive treatment,the fluctuation of 24h ambulatory blood pressure of both the patients with simple hypertension and those combined with OSAS were in normal level（〈130/80mmHg）.The nocturnal reduction rate in the simple hypertension group or combined with OSAS group was lower than that in the control group（P〈0.05 or P〈0.01）.Among them,the nocturnal reduction rate in the moderate subgroup and the severe subgroup were the lowest（P〈0.05）.The blood pressure curves of reverse-dippers in the combined with OSAS group were more than those in the group with simple hypertension（P〈0.05）,and those in the severe OSAS subgroup were the most with no obvious morning blood pressure surge（P〈0.05）.Conclusion The blood pressure level was up to par after the treatment of antihypertensio in patients of elderly hypertension with OSAS,but the daytime and the nighttime circadian rhythm was not improved.