睡眠呼吸暂停综合征与高血压治疗

目的　观察合并睡眠呼吸暂停综合征 (SAS)的高血压病患者 ,常规药物降压治疗及呼吸道正压通气治疗对血压的影响。方法　按照睡眠资料和 2 4h血压资料 ,分为单纯高血压组与合并SAS高血压组 ,观察常规降压药物治疗 4周后 2 4h血压变化及呼吸道正压通气治疗对合并SAS的高血压患者 2 4h血压影响。结果　 2 7例单纯高血压患者 ,常规药物降压治疗 4周后 ,2 4h平均收缩压、舒张压、夜间收缩压、舒张压均明显下降 (P <0 0 1)。 2 5例合并SAS的高血压患者 2 4h平均收缩压、舒张压、夜间舒张压有所下降 (P <0 0 5 ) ,但仍高于正常值 ,而夜间收缩压无明显变化。其中 19例合并SAS高血压患者加用一夜正压通气治疗后 ,2 4h平均血压进一步下降 ,夜间收缩压和舒张压明显降低 (P <0 0 1,P <0 0 1)。结论　合并有SAS的高血压患者多为难治性 ,单纯降压药物治疗效果欠佳 ,需要同时应用正压通气进行治疗。

Sleep apnea syndrome and hypertension treatment

Objective To analyse the efficacy of antihypertensive therapy in hypertensive patients with sleep apnea syndrome (SAS) and compare the data from 24 h BP monitoring before and after CPAP treatment. Methods We used 24 hour ABPM and polysomnography (PSG) simultaneously to classify the hypertensive patients and the hypertensive patients with SAS. We analysis antihypertensed therapy effect on the patients with hypertension and on the hypertensive patients with SAS after 4 weeks antihypertensive treatment. For the hypertensive patients with SAS, we also compared the data from 24h ambulatory blood pressure before and after CPAP treatment. Results After 4 weeks antihypertensive treatment, 24h BP and nighttime BP decreased in the 27 hypertensive patients, and decreased mildly in the 25 hypertensive patients with SAS. In 19 hypertensive patients with SAS, nighttime Bp decreased after one night CPAP treatment. Conclusion Most hypertensive patients with SAS are refractory to antihypertensive drug treatment, and CPAP treatment should be considered in these patients.