阻塞性睡眠呼吸暂停患者睡眠时高血压的发生

目的明确阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者清醒及睡眠时血压变化情况及对其影响的相关因素。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，部分患者观察吸氧或经鼻（面）罩持续正压通气（ＮＣＰＡＰ）的治疗效果。结果（１）ＯＳＡＳ患者白天高血压发生率为４６％（６／１３）；白天无高血压的患者夜间一过性高血压发生率为８６％（６／７）；（２）ＯＳＡＳ患者夜间血压增高与低氧血症和呼吸暂停时间有关，与呼吸暂停指数（ＡＩ）无相关性（Ｐ＞０．０５）；（３）２例ＯＳＡＳ患者经吸氧治疗后，夜间血压波动仍存在，高血压未得到纠正；４例ＯＳＡＳ患者经ＮＣＰＡＰ治疗后，夜间血压波动消失。结论白天无高血压的ＯＳＡＳ患者夜间可反复出现一过性血压增高；ＯＳＡＳ患者夜间血压增高与低氧血症、呼吸暂停时间有关，但低氧血症不是引起夜间血压增高的主要因素；单纯吸氧不能纠正ＯＳＡＳ患者夜间血压增高，ＮＣＰＡＰ是纠正ＯＳＡＳ患者夜间血压增高的较好方法。

The occurrence of hypertension in patients with obstructive sleep apnea syndrome

Objective To determine the changes in blood pressure (BP) and its correlated factors in patients with obstructive sleep apnea syndrome(OSAS). Method Retaining manometric tube in radial artery and polysomnography(PSG) were done synchronously in 13 patients with OSAS in whom was diagnosed by whole night PSG. Oxygen therapy was given to two of the patients and NCPAP treatment was given to four of the patients on the following night. Result (1) Six of the patients (46 percent ) had daytime hypertension (SBP>18.7 kPa and/or DBP>12kPa), the incidence of transient hypertension during apnea in 7 patients who do not have daytime hypertension was 86% (6/7) . (2)Lowest oxygen saturation during sleep was significantly correlated with the level of SBP( r = 0.659, P <0.05) and DBP( r = 0.677, P <0.01) in awake, the baseline of SBP( r = 0.777, P < 0.01) and DBP ( r = 0.590, P <0.05) in NREM sleep and that of SBP( r = 0.585, P <0.05) in REM sleep. In REM sleep, the changes in MBP showed significantly correlation with the changes in oxygen saturation during apnea ( r =0.598, P <0.05). In NREM sleep, the changes in SBP were significantly correlated with apnea length( r =0.580, P <0.05). The changes in BP showed no correlation with apnea index in different sleep stages ( P >0.05). (3) Nocturnal elevation in BP disappeared in four patients who received NCPAP treatment,but not in two patients who received oxygen therapy. Conclusion The transient hypertension during apnea might be recurrent episodes in patients with OSAS who have normal daytime BP.Nocturnal hypoxemia and apnea length might play a role in nocturnal elevation in BP in patients with OSAS.Hypoxemia was not the major factor in BP elevation after obstructive apneas. Simple oxygen administration could not normalize the elevation in BP during apnea in patients with OSAS and NCPAP might be an appropriate therapy.