阻塞性睡眠呼吸暂停综合征合并高血压患者动态血压的相关研究

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者动态血压的变化。方法：对120例高血压伴鼾症患者同步进行24h动态血压监测（ABPM）及多导睡眠监测（PSG），根据睡眠呼吸暂停低通气指数（AHI）分为轻、中、重度OSAS合并高血压组共3组，观察并比较3组基线资料、睡眠监测指标、动态血压监测各指标，根据不同的血压昼夜节律状况分组（杓型组、非杓型组），比较睡眠监测指标、动态血压监测各指标。结果：（1）重度OSAS合并高血压患者白昼平均舒张压（dDBP）、夜间平均舒张压（nDBP）高于轻、中度组（P〈0．05），偶测收缩压（cSBP）高于轻度组（P〈0．05）。（2）最低血氧饱和度（minSaO2）同24h平均收缩压（24hSBP）、白昼平均收缩压（dSBP）呈负相关。AHI与偶侧舒张压（cDBP）呈正相关。（3）根据血压昼夜节律状况进行分组，非杓型组占全部患者的68．3％，随着OSAS病情的加重，血压昼夜节律消失者比例增多（P〈0．05）。杓型组minSaO2、夜间平均收缩压（nSBP）及nDBP明显低于非杓型组患者（P〈0．05）。结论：频繁缺氧在OSAS患者舒张压升高中的作用更为显著；OSAS病情的严重程度与血压昼夜节律异常密切相关。

Study on 24-hour blood pressure in patients with OSAS complicating hypertension

Objective:To study the changes on 24-hour blood pressure in patients with OSAS complicating hypertension.Methods:Polysomnography(PSG) and 24 hours ambulatory blood pressure monitoring(ABPM) were performed in 120 patients with OSAS complicating hypertension.Accoring to apnea-hypopnea index(AHI),120 OSAS patients complicating hypertension were divided into three groups,mild group,moderate group and severe group.Base line data,PSG data and ABPM data were observed.Results:(1) Day diastolic blood pressure(dDBP) and night diastolic blood pressure(nDBP) in severe group are higher than those in other two groups(P<0.05).(2) The minimum oxygen saturation(minSaO2) has negative correlation with 24 hour mean systolic blood pressure(24 hSBP) and 24 hour mean diastolic blood pressure(24 hDBP).Apnea hyponea index(AHI) has positive correlation with change of diastolic blood pressure(cDBP).(3) The day-nocturnal rhythm has disappeared in 68.3% patients.With the higher of apnea-hypopnea index(AHI),OSAS patiants' percentage of the day-nocturnal rhythm disappeared was increasing.The differences of nocturnal mean systolic blood pressure(nSBP),nDBP and minSaO2 between dipper group and non-dipper group were statistically significant(P<0.05).Conclusion:Frequent oxygen deficiency plays a more important role in elevating diastolic blood pressure of OSAS patients;The degree of OSAS patient's condition and abnormal nocturnal rhythm are close correlated.