合并阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血压变异性研究

目的 探讨合并阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）急性脑梗死患者的血压变异情况与脑梗死之间关系。方法 将急性脑梗死患者分为合并OSAS组（n=126）和无OSAS组（对照组，n=51）。用24 h动态血压监测测得的血压标准差代表血压变异性。分析两组24 h的收缩压、舒张压、血压标准差、美国国立卫生院卒中量表（the National Institutes of Health Stroke Scale，NIHSS）评分及其他相关资料的差异。同时进一步分析基线资料、主要合并症与复发性脑梗死的相关性。结果 OSAS组与对照组比较，夜间收缩压标准差（12.1±4.7 vs 8.8±3.7，P=0.001）、白天平均收缩压（138.9±17.8 mmHg vs 131.4±15.8 mmHg，P=0.008）、NIHSS评分［3.0（2.0～8.75）分 vs 2.5（2.0～4.0）分，P=0.013］、合并脑梗死病史比例数（61.1% vs 41.2%，P=0.006）差异有统计学意义。Logistic回归分析显示高血压病史、合并OSAS、呼吸暂停低通气指数（apnea hypopnea index，AHI）及夜间收缩压标准差与复发性脑梗死相关，矫正了相关危险因素后夜间收缩压标准差是复发性脑梗死的独立危险因素（OR 0.910，95%CI 0.855～0.969，P=0.003）。结论 合并OSAS的急性脑梗死患者的夜间血压变异性增大，可能是导致脑梗死复发的原因之一

Study of Blood Pressure Variability in Acute Cerebral Infarction with Obstructive Sleep Apnea Syndrome

Objective To assess the blood pressure variability（BPV） in acute infarction with obstructive sleep apnea syndrome（OSAS）, and to explore the relationship between BPV and stroke. Methods We studied patients with acute cerebral infarction. All of the patients were admitted to the department of neurology, Beijing Haidian Hospital, from Jan. 2009 to Jun. 2010. Overnight polysomnography（PSG） and 24-hour ambulatory blood pressure monitoring recordings were performed on all patients within the first week from the onset of the ischemic stroke. According to the PSG, patients were divided into OSAS group（n=126） and non-OSAS group（n=51） except the patients with central and mixed sleep apnea syndrome and taking anti-hypertension drugs. BPV was expressed as the standard deviation of blood pressure（BP） during a 24 period. The aim of study is to determine the relationships in BP, BPV, the National Institutes of Health Stroke Scale（NIHSS）, and so on between groups. Data was analyzed by spssl 1.5. We used for nominal variables the X^2 test or t test. Singnificance was set at P〈0.05. The correlations between tile baseline data, clinical complications and recurrent stroke were studied. Results There were significantly higher daytime systolic（ 138.9±17.8 mmHg vs 131.4±15.8 mmH g, and P-value is less than 0.01）, nighttime BPV（12.1±4.7 mmHg vs 8.8±3.7 mmHg, and P-value is less than 0.01 ） in the OSAS group as compared to the non-OSAS group. There were significantly differences in NIHSS and the number of recurrence stroke between two groups. Hypertention, diabetes mellitus, OSAS, apnea hypopnea index（AHl） and nighttime BPV were related to recurrent stroke（P〈0.05）. After adjustment for the other factors, nighttime BPV（OR 0.910, 95%C1 0.855-0.969, P=-0.003） was a independent risk factor of recurrent stroke. Conclusion The nighttime-BPV was higher in the OSAS group as compared to the non-OSAS group The BPV was one of the reasons of recurrence of stroke in patients with OSAS.