睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究_《中國呼吸與危重監護雜志》

作者：

楊琳 ,  何權瀛 , 羅華 , 韓芳 , 李靜 , 韓旭

北京大學人民醫院呼吸內科（北京 100044）;

關鍵詞：

阻塞性睡眠呼吸暫停低通氣綜合征高血壓呼吸暫停低通氣指數

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目的探討阻塞性睡眠呼吸暫停低通氣綜合征（OSAHS）在高血壓病發病中的作用。方法納入2003年9月~2007年9月在呼吸睡眠監測中心就診、Epworth嗜睡量表評分 gt;9分的成年患者，進行多導睡眠圖（PSG）和血壓檢測，根據睡眠呼吸暫停低通氣指數（AHI）將所有對象分為4組，比較各組患者睡前與醒后的血壓變化；了解血壓變化與PSG的各項指標的相互關系。結果共1 528例患者入選。非OSAHS組患者(AHI lt;5次/h，n=172)的睡前、醒后血壓無顯著差異（P gt;0.05）；輕度OSAHS組患者(AHI≤20次/h，n=435)的舒張壓升高1.73 mm Hg；中度OSAHS組患者(AHI≤40次/h，n=307)的收縮壓和舒張壓分別升高3.52 mm Hg和3.71 mm Hg；重度OSAHS組患者(AHI gt;40次/h，n=614)的收縮壓和舒張壓分別升高3.72 mm Hg和4.22 mm Hg。輕度OSAHS組患者夜間收縮壓的變化與微覺醒指數呈顯著正相關（r=0.25，P lt;0.05）。中度OSAHS組患者夜間收縮壓的變化與體重指數（BMI）呈顯著正相關（r=0.25，P lt;0.05）。重度OSAHS組患者夜間收縮壓的變化與BMI、最長呼吸暫停時間呈正相關（r值分別為0.26和0.25，P均 lt;0.05）；夜間舒張壓的變化與AHI、平均呼吸暫停時間（MA）呈正相關（r值分別為0.22和0.17，P均 lt;0.05）；夜間平均血壓的變化與AHI和MA呈正相關（r值分別為0.25和0.20，P lt;0.05）。結論 OSAHS可引起夜間血壓升高，但幅度不大；影響血壓的因素因OSAHS的嚴重程度不同而各異。

引用本文： 楊琳 ,何權瀛,羅華,韓芳,李靜,韓旭. 睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究. 中國呼吸與危重監護雜志, 2008, 08(2): 110-115. doi: 復制

1.	Chobanian AV,Bakris GL,Black HR,et al.The Seventh Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure:The JNC 7 report.JAMA,2003,289:2560-2572.
2.	中華醫學會呼吸病學分會睡眠呼吸疾病學組.阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案).中華內科雜志,2003,42:594-597.
3.	Durán J,Esnaola S,Rubio R,et al.Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr.Am J Respir Crit Care Med,2001,163:685-689.
4.	Pankow W,Lies A,Lohmann FW.Sleep-disordered breathing and hypertension.N Engl J Med,2000,343:966.
5.	Nieto FJ,Young TB,Ling BK,et al.Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study.Sleep Heart Health Study.JAMA,2000,283:1829-1836.
6.	Peppard PE,Young T,Palta M,et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl Med,2000,342:1378-1384.
7.	Kales A,Bixler EO,Cadieux RJ,et al.Sleep apnoea in a hypertensive population.Lancet,1984,2:1005-1008.
8.	Lavie P,Ben Yosef R,Rubin AE.Prevalence of sleep apnea syndrome among patients with essential hypertension.Am Heart J,1984,108:373-376.
9.	Fletcher EC,DeBehnke RD,Lovoi MS,et al.Undiagnosed sleep apnea in patients with essential hypertension.Ann Intern Med,1985,103:190-195.
10.	Young T,Peppard PE,Gottlieb DJ,et al.Epidemiology of obstructive sleep apnea:a population health perspective.Am J Respir Crit Care Med,2002,165:1217-1239.
11.	中華醫學會呼吸病學分會睡眠呼吸疾病學組.睡眠呼吸暫停人群高血壓患病率的多中心研究.中華結核和呼吸雜志,2007,30:894-897.
12.	Leng PH,Mosharraf-Hossain AK,Chan YH,et al.The clinical predictors of hypertension and sleepiness in an Asian population with sleep-disordered breathing.Ann Acad Med Singapore,2006,35:6-10.
13.	Lavie P,Herer P,Hoffsein V.Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.BMJ,2000,320:479-482.
14.	Somers VK,Dyken ME,Clary MP,et al.Sympathetic neural mechanisms in obstructive sleep apnea.J Clin Invest,1995,96:1897-1904.
15.	van den Aardweg JG,Karemaker JM.Repetitive apneas induce periodic hypertension in normal subjects through hypoxia.J Appl Physiol,1992,72:821-827.
16.	Kobayashi H,Ishibashi K,Noguchi H.Heart rate variability; an index for monitoring and analyzing human autonomic activities.Appl Human Sci,1999,18:53-59.
17.	Narkiewicz K,Somers VK.Cardiovascular variability characteristics in obstructive sleep apnea..Auton Neurosci,2001,90:89-94.

1. Chobanian AV,Bakris GL,Black HR,et al.The Seventh Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure:The JNC 7 report.JAMA,2003,289:2560-2572.
2. 中華醫學會呼吸病學分會睡眠呼吸疾病學組.阻塞性睡眠呼吸暫停低通氣綜合征診治指南(草案).中華內科雜志,2003,42:594-597.
3. Durán J,Esnaola S,Rubio R,et al.Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr.Am J Respir Crit Care Med,2001,163:685-689.
4. Pankow W,Lies A,Lohmann FW.Sleep-disordered breathing and hypertension.N Engl J Med,2000,343:966.
5. Nieto FJ,Young TB,Ling BK,et al.Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study.Sleep Heart Health Study.JAMA,2000,283:1829-1836.
6. Peppard PE,Young T,Palta M,et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl Med,2000,342:1378-1384.
7. Kales A,Bixler EO,Cadieux RJ,et al.Sleep apnoea in a hypertensive population.Lancet,1984,2:1005-1008.
8. Lavie P,Ben Yosef R,Rubin AE.Prevalence of sleep apnea syndrome among patients with essential hypertension.Am Heart J,1984,108:373-376.
9. Fletcher EC,DeBehnke RD,Lovoi MS,et al.Undiagnosed sleep apnea in patients with essential hypertension.Ann Intern Med,1985,103:190-195.
10. Young T,Peppard PE,Gottlieb DJ,et al.Epidemiology of obstructive sleep apnea:a population health perspective.Am J Respir Crit Care Med,2002,165:1217-1239.
11. 中華醫學會呼吸病學分會睡眠呼吸疾病學組.睡眠呼吸暫停人群高血壓患病率的多中心研究.中華結核和呼吸雜志,2007,30:894-897.
12. Leng PH,Mosharraf-Hossain AK,Chan YH,et al.The clinical predictors of hypertension and sleepiness in an Asian population with sleep-disordered breathing.Ann Acad Med Singapore,2006,35:6-10.
13. Lavie P,Herer P,Hoffsein V.Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.BMJ,2000,320:479-482.
14. Somers VK,Dyken ME,Clary MP,et al.Sympathetic neural mechanisms in obstructive sleep apnea.J Clin Invest,1995,96:1897-1904.
15. van den Aardweg JG,Karemaker JM.Repetitive apneas induce periodic hypertension in normal subjects through hypoxia.J Appl Physiol,1992,72:821-827.
16. Kobayashi H,Ishibashi K,Noguchi H.Heart rate variability; an index for monitoring and analyzing human autonomic activities.Appl Human Sci,1999,18:53-59.
17. Narkiewicz K,Somers VK.Cardiovascular variability characteristics in obstructive sleep apnea..Auton Neurosci,2001,90:89-94.

《中國呼吸與危重監護雜志》

睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究

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《中國呼吸與危重監護雜志》

睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究

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