阻塞性睡眠呼吸暫停綜合征與高血壓_《中國呼吸與危重監護雜志》

作者：

王菡僑 ¹ , 何權瀛 ²

1 河北醫科大學第三醫院呼吸睡眠科（河北石家莊 050051）;;
2 北京大學人民醫院呼吸科;

關鍵詞：

阻塞性睡眠呼吸暫停綜合征高血壓

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阻塞性睡眠呼吸暫停綜合征（OSAS）是在睡眠過程中上氣道完全或部分狹窄導致患者反復呼吸暫停或低通氣，出現鼾聲、低氧血癥及睡眠中反復微覺醒引起日間疲乏、嗜睡等癥狀的一組癥候群。高血壓是以體循環動脈壓升高為主要特點的臨床綜合征，是最常見的心血管疾病，也是現代社會最主要的流行病之一。近十幾年來，越來越多的研究證實OSAS與高血壓的形成與發展獨立相關，是非常重要的致高血壓發生的危險因素[1-4]。
動脈壓持續升高可導致心、腦、腎和血管等損害，并可引起全身代謝異常，嚴重危害人類的健康。但同時高血壓又是可以防治的疾病，有效控制血壓可明顯地降低心腦血管疾病的死亡率。然而臨床上難治性高血壓的發生比例逐漸增加，原因之一在于部分由OSAS引起的繼發性高血壓被誤診為原發性高血壓，從而使這些患者未得到根本性的病因治療[5，6]。因此，如何預防和減少OSAS引起的高血壓成為現代醫學關注的焦點。本文將從流行病學、發病機制、臨床意義及治療幾個方面論述OSAS與高血壓之間的相關性。

引用本文： 王菡僑 ,何權瀛. 阻塞性睡眠呼吸暫停綜合征與高血壓. 中國呼吸與危重監護雜志, 2008, 08(4): 313-317. doi: 復制

1.	Nieto FJ，Young TB，Lind 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.
2.	Young T，Peppard P，Palta M，et al.Population-based study of sleep-disordered breathing as a risk factor for hypertension.Arch Intern Med，1997，157：1746-1752.
3.	Peppard PE，Young T，Palta M，et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl J Med，2000，342：1378-1384.
4.	Borgel J，Sanner BM，Keskin F，et al.Obstructive sleep apnea and blood pressure，interaction between the blood pressure-lowering effects of positive airway pressure therapy and antihypertensive drugs.Am J Hypertens，2004，17：1081-1087.
5.	Silverberg DS，Iaina A，Oksenberg A.Treating obstructive sleep apnea improves essential hypertension and quality of life.Am Fam Phys，2002，65：229-236.
6.	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.
7.	Drager LF，Pereira AC，Barreto-Filho JA.Phenotypic characteristics associated with hypertension in patients with obstructive sleep apnea.J Hum Hypertens，2006，20：523-528.
8.	Wang H，Zhang X，Yang Y，.et al.Relationship between sleep apnea hypopnea syndrome and cardiovascular events in elderly Chinese snorers.Chin Med J (Engl)，2002，115：1829-1832.
9.	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.
10.	Schulz R，Grebe M，Eisele HJ，et al.Obstructive sleep apnea-related cardiovascular disease.Med Klin(Munich)，2006，101：321-327.
11.	Hedner J，Bengtsson-Bostrom K，Peker Y，et al.Hypertension prevalence in obstructive sleep apnoea and sex：a population-based case-control study.Eur Respir J，2006，27：564-570.
12.	Brooks D，Horner RL，Kozar LF，et al.Obstructive sleep apnea as a cause of systemic hypertension.Evidence from a canine model.J Clin Invest，1997，99：106-109.
13.	Bao G，Metreveli N，Fletcher EC.Acute and chronic blood pressure response to recurrent acoustic arousal in rats.Am J Hypertens，1999，12：504-510.
14.	Somers VK，Dyken ME，Clary MP，et al.Sympathetic neural mechanisms in obstructive sleep apnea.J Clin Invest，1995，96：1897-1904.
15.	Fletcher EC，Bao G.Effect of episodic eucapnic and hypocapnic hypoxia on systemic blood pressure in hypertension-prone rats.J Appl Physiol，1996，81：2088-2094.
16.	Bao G，Metreveli N，Li R，et al.Blood pressure response to chronic episodic hypoxia：role of the sympathetic nervous system.J Appl Physiol，1997，83：95-101.
17.	Cuspidi C，Macca G，Sampieri L，et al.Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients.J Hypertens，2001，19：1539-1545.
18.	Kario K，Pickering TG，Umeda Y，et al.Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives：a prospective study.Circulation，2003，107：1401-1406.
19.	Cuspidi C，Meani S，Salerno M，et al.Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure.J Hypertens，2004，22：273-280.
20.	Peter JH，Grote L，Fus E，et al.REM-sleep-hypertension in obstructive sleep apnea.Eur J Med Res，1995，18：132-136.
21.	Loredo JS，Ancoli-Israel S，Dimsdale JE.Sleep quality and blood pressure dipping in obstryctive sleep apnea.Am J Hypertens，2001，14：887-892.
22.	Akashiba T，Minemura H，Yamamoto H，et al.Nasal continuous positive airway pressure changes blood pressure "non-dippers" to "dippers" in patients with obstructive sleep apnea.Sleep，1999，22：849-853.
23.	Noda A，Yasuma F，Okada T，et al.Influence of movement arousal on circadian rhythm of blood pressure in obstructive sleep apnea syndrome.J Hypertens，2000，18：539-544.
24.	周燕斌，謝燦茂，嚴英碩，等.阻塞性睡眠呼吸暫停對動態血壓影響的研究.中國實用內科雜志，2003，6：343-345.
25.	Suzuki M，Guilleminault C，Otsuka K，et al.Blood pressure "dipping" and "non-dipping" in obstructive sleep apnea syndrome patients.Sleep，1996，19：382-387.
26.	Nabe B，Lies A，Pankow W，et al.Determinants of circadian blood pressure rhythm and blood pressure variability in obstructive sleep apnoea.J Sleep Res，1995，4(S1)：97-101.
27.	Loredo JS，Nelesen R，Ancoli-Israel S，et al.Sleep quality and blood pressure dipping in normal adults.Sleep，2004，27：1097-1103.
28.	Silva AP，Moreira C，Bicho M，et al.Nocturnal sleep quality and circadian blood pressure variation.Rev Port Cardiol，2000，19：991-1005.
29.	Portaluppi F，Provini F，Cortelli P，et al.Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension.J Hypertens，1997，15：1227-1233.
30.	邱原剛，姚雪艷，陶謙民，等.高血壓患者治療后血壓晝夜節律及影響因素的調查.中華流行病學雜志2004，25：710-714.
31.	Logan AG，Perlikowski SM，Mente A，et al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertension.J Hypertens，2001，19：2271-2277.
32.	Hla KM，Skatrud JB，Finn L，et al.The effect of correction of sleep-disordered breathing on BP in untreated hypertension.Chest，2002，122：1125-1132.
33.	Wilcox I，Grunstein RR，Hedner JA，et al.Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea.Sleep，1993，16：539-544.
34.	Sanner BM，Tepel M，Markmann A，et al.Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome.Am J Hypertens，2002，15：251-257.
35.	夏書月，吳藝紅，胡榮芳，等.持續正壓通氣治療阻塞性睡眠呼吸暫停綜合征合并高血壓患者的動態血壓變化.中國呼吸與危重監護雜志，2003，2：174-176.
36.	Pepperell JC，Ramdassingh-Dow S，Crosthwaite N，et al.Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea：a randomised parallel trial.Lancet，2002，359：204-210.
37.	Kaneko Y，Floras JS，Usui K，et al.Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea.N Engl J Med，2003，348：1233-1241.
38.	Usui K，Bradley TD，Spaak J，et al.Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure.J Am Coll Cardiol，2005，21，45：2008-2011.
39.	Dimsdale JE，Loredo JS，Profant J，et al.Effect of continuous positive airway pressure on blood pressure：a placebo trial.Hypertension，2000，35：144-147.
40.	Logan AG，Tkacova R，Perlikowski SM，et al.Refractory hypertension and sleep apnoea：effect of CPAP on blood pressure and baroreflex.Eur Respir J，2003，21：241-247.
41.	Tun Y，Hida W，Okabe S，et al.Can nasal continuous positive airway pressure decrease clinic blood pressure in patients with obstructive sleep apnea? Tohoku J Exp Med，2003，201：181-190.
42.	Becker HF，Jerrentrup A，Ploch T，et al.Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea.Circulation，2003，107：68-78.
43.	Pankow W，Nabe B，Lies A，et al.Influence of obstructive sleep apnoea on circadian blood pressure profile.J Sleep Res，1995，4(S1)：102-106.
44.	Gotsopoulos H，Kelly JJ，Cistulli PA.Oral appliance therapy reduces blood pressure in obstructive sleep apnea：a randomized，controlled trial.Sleep，2004，27：934-941.

1. Nieto FJ，Young TB，Lind 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.
2. Young T，Peppard P，Palta M，et al.Population-based study of sleep-disordered breathing as a risk factor for hypertension.Arch Intern Med，1997，157：1746-1752.
3. Peppard PE，Young T，Palta M，et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl J Med，2000，342：1378-1384.
4. Borgel J，Sanner BM，Keskin F，et al.Obstructive sleep apnea and blood pressure，interaction between the blood pressure-lowering effects of positive airway pressure therapy and antihypertensive drugs.Am J Hypertens，2004，17：1081-1087.
5. Silverberg DS，Iaina A，Oksenberg A.Treating obstructive sleep apnea improves essential hypertension and quality of life.Am Fam Phys，2002，65：229-236.
6. 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.
7. Drager LF，Pereira AC，Barreto-Filho JA.Phenotypic characteristics associated with hypertension in patients with obstructive sleep apnea.J Hum Hypertens，2006，20：523-528.
8. Wang H，Zhang X，Yang Y，.et al.Relationship between sleep apnea hypopnea syndrome and cardiovascular events in elderly Chinese snorers.Chin Med J (Engl)，2002，115：1829-1832.
9. 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.
10. Schulz R，Grebe M，Eisele HJ，et al.Obstructive sleep apnea-related cardiovascular disease.Med Klin(Munich)，2006，101：321-327.
11. Hedner J，Bengtsson-Bostrom K，Peker Y，et al.Hypertension prevalence in obstructive sleep apnoea and sex：a population-based case-control study.Eur Respir J，2006，27：564-570.
12. Brooks D，Horner RL，Kozar LF，et al.Obstructive sleep apnea as a cause of systemic hypertension.Evidence from a canine model.J Clin Invest，1997，99：106-109.
13. Bao G，Metreveli N，Fletcher EC.Acute and chronic blood pressure response to recurrent acoustic arousal in rats.Am J Hypertens，1999，12：504-510.
14. Somers VK，Dyken ME，Clary MP，et al.Sympathetic neural mechanisms in obstructive sleep apnea.J Clin Invest，1995，96：1897-1904.
15. Fletcher EC，Bao G.Effect of episodic eucapnic and hypocapnic hypoxia on systemic blood pressure in hypertension-prone rats.J Appl Physiol，1996，81：2088-2094.
16. Bao G，Metreveli N，Li R，et al.Blood pressure response to chronic episodic hypoxia：role of the sympathetic nervous system.J Appl Physiol，1997，83：95-101.
17. Cuspidi C，Macca G，Sampieri L，et al.Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients.J Hypertens，2001，19：1539-1545.
18. Kario K，Pickering TG，Umeda Y，et al.Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives：a prospective study.Circulation，2003，107：1401-1406.
19. Cuspidi C，Meani S，Salerno M，et al.Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure.J Hypertens，2004，22：273-280.
20. Peter JH，Grote L，Fus E，et al.REM-sleep-hypertension in obstructive sleep apnea.Eur J Med Res，1995，18：132-136.
21. Loredo JS，Ancoli-Israel S，Dimsdale JE.Sleep quality and blood pressure dipping in obstryctive sleep apnea.Am J Hypertens，2001，14：887-892.
22. Akashiba T，Minemura H，Yamamoto H，et al.Nasal continuous positive airway pressure changes blood pressure "non-dippers" to "dippers" in patients with obstructive sleep apnea.Sleep，1999，22：849-853.
23. Noda A，Yasuma F，Okada T，et al.Influence of movement arousal on circadian rhythm of blood pressure in obstructive sleep apnea syndrome.J Hypertens，2000，18：539-544.
24. 周燕斌，謝燦茂，嚴英碩，等.阻塞性睡眠呼吸暫停對動態血壓影響的研究.中國實用內科雜志，2003，6：343-345.
25. Suzuki M，Guilleminault C，Otsuka K，et al.Blood pressure "dipping" and "non-dipping" in obstructive sleep apnea syndrome patients.Sleep，1996，19：382-387.
26. Nabe B，Lies A，Pankow W，et al.Determinants of circadian blood pressure rhythm and blood pressure variability in obstructive sleep apnoea.J Sleep Res，1995，4(S1)：97-101.
27. Loredo JS，Nelesen R，Ancoli-Israel S，et al.Sleep quality and blood pressure dipping in normal adults.Sleep，2004，27：1097-1103.
28. Silva AP，Moreira C，Bicho M，et al.Nocturnal sleep quality and circadian blood pressure variation.Rev Port Cardiol，2000，19：991-1005.
29. Portaluppi F，Provini F，Cortelli P，et al.Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension.J Hypertens，1997，15：1227-1233.
30. 邱原剛，姚雪艷，陶謙民，等.高血壓患者治療后血壓晝夜節律及影響因素的調查.中華流行病學雜志2004，25：710-714.
31. Logan AG，Perlikowski SM，Mente A，et al.High prevalence of unrecognized sleep apnoea in drug-resistant hypertension.J Hypertens，2001，19：2271-2277.
32. Hla KM，Skatrud JB，Finn L，et al.The effect of correction of sleep-disordered breathing on BP in untreated hypertension.Chest，2002，122：1125-1132.
33. Wilcox I，Grunstein RR，Hedner JA，et al.Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea.Sleep，1993，16：539-544.
34. Sanner BM，Tepel M，Markmann A，et al.Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome.Am J Hypertens，2002，15：251-257.
35. 夏書月，吳藝紅，胡榮芳，等.持續正壓通氣治療阻塞性睡眠呼吸暫停綜合征合并高血壓患者的動態血壓變化.中國呼吸與危重監護雜志，2003，2：174-176.
36. Pepperell JC，Ramdassingh-Dow S，Crosthwaite N，et al.Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea：a randomised parallel trial.Lancet，2002，359：204-210.
37. Kaneko Y，Floras JS，Usui K，et al.Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea.N Engl J Med，2003，348：1233-1241.
38. Usui K，Bradley TD，Spaak J，et al.Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure.J Am Coll Cardiol，2005，21，45：2008-2011.
39. Dimsdale JE，Loredo JS，Profant J，et al.Effect of continuous positive airway pressure on blood pressure：a placebo trial.Hypertension，2000，35：144-147.
40. Logan AG，Tkacova R，Perlikowski SM，et al.Refractory hypertension and sleep apnoea：effect of CPAP on blood pressure and baroreflex.Eur Respir J，2003，21：241-247.
41. Tun Y，Hida W，Okabe S，et al.Can nasal continuous positive airway pressure decrease clinic blood pressure in patients with obstructive sleep apnea? Tohoku J Exp Med，2003，201：181-190.
42. Becker HF，Jerrentrup A，Ploch T，et al.Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea.Circulation，2003，107：68-78.
43. Pankow W，Nabe B，Lies A，et al.Influence of obstructive sleep apnoea on circadian blood pressure profile.J Sleep Res，1995，4(S1)：102-106.
44. Gotsopoulos H，Kelly JJ，Cistulli PA.Oral appliance therapy reduces blood pressure in obstructive sleep apnea：a randomized，controlled trial.Sleep，2004，27：934-941.

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阻塞性睡眠呼吸暫停綜合征與高血壓

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阻塞性睡眠呼吸暫停綜合征與高血壓

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