CAJ | 학술논문

目的：探讨睡眠呼吸暂停综合征（ obstructive sleep apnea syndrome ， OSAS）与晨峰血压、心率变异性的关系。方法对64例检查明确为OSAS，且合并原发性高血压的患者行24 h动态血压监测和动态心电图监测，按OSAS合并高血压患者是否合并血压晨峰分为两组：OSAS合并高血压病伴血压晨峰组（晨峰组）33例，OSAS合并高血压病不伴血压晨峰组（非晨峰组）31例，以及同期健康体检人员30例作为对照组，比较3组睡眠呼吸监测结果及血压昼夜节律变化和心率变异性结果。结果晨峰组及非晨峰组和对照组比较，呼吸紊乱指数（AHI）增高（P＜0.01），最低血氧饱和度降低（P＜0.01），血压昼夜节律均有明显改变（ P＜0.01）；晨峰组和非晨峰组比较，AHI、最低血氧饱和度和血压昼夜节律也有所不同，晨峰组AHI更高（P＜0.05），最低血氧饱和度更低（P＜0.05），非杓型血压昼夜节律者明显增多（P＜0.05）。关于心率变异性，晨峰组及非晨峰组和对照组相比，低频谱、LF/HF增高（ P＜0.05），高频谱、SDNN、PNN50、HRVI降低（ P＜0.05），晨峰组和非晨峰组的HRVI相比也有显著性差异（ P＜0.05），其它指标在数值上也有差异，但差异没有统计学意义（ P＞0.05）。结论 OSAS合并高血压病伴血压晨峰AHI更高，最低血氧饱和度更低，非杓型血压昼夜节律者明显增多，自主神经损伤程度更严重，更容易发生心脑血管不良事件。
목적：탐토수면호흡잠정종합정（ obstructive sleep apnea syndrome ， OSAS）여신봉혈압、심솔변이성적관계。방법대64례검사명학위OSAS，차합병원발성고혈압적환자행24 h동태혈압감측화동태심전도감측，안OSAS합병고혈압환자시부합병혈압신봉분위량조：OSAS합병고혈압병반혈압신봉조（신봉조）33례，OSAS합병고혈압병불반혈압신봉조（비신봉조）31례，이급동기건강체검인원30례작위대조조，비교3조수면호흡감측결과급혈압주야절률변화화심솔변이성결과。결과신봉조급비신봉조화대조조비교，호흡문란지수（AHI）증고（P＜0.01），최저혈양포화도강저（P＜0.01），혈압주야절률균유명현개변（ P＜0.01）；신봉조화비신봉조비교，AHI、최저혈양포화도화혈압주야절률야유소불동，신봉조AHI경고（P＜0.05），최저혈양포화도경저（P＜0.05），비표형혈압주야절률자명현증다（P＜0.05）。관우심솔변이성，신봉조급비신봉조화대조조상비，저빈보、LF/HF증고（ P＜0.05），고빈보、SDNN、PNN50、HRVI강저（ P＜0.05），신봉조화비신봉조적HRVI상비야유현저성차이（ P＜0.05），기타지표재수치상야유차이，단차이몰유통계학의의（ P＞0.05）。결론 OSAS합병고혈압병반혈압신봉AHI경고，최저혈양포화도경저，비표형혈압주야절률자명현증다，자주신경손상정도경엄중，경용역발생심뇌혈관불량사건。
Objective To investigate the relationship of sleep apnea syndrome to morning blood pressure surge and heart rate variability .Methods Sixty-four patients with obstructive sleep apnea syndrome ( OSAS) and essential hypertention underwent 24-hour ambulatory blood pressure monitoring (ABPM) and 24-hour Holter.According to ABPM, they were divided into two groups:the morning blood pressure surge group ( MBPS group ) included 33 patients and the non-MBPS group with 31.In addition, the control guoup consisted of 30 healthy persons at the same time.The parameters in sleep-breathing monitoring ,circadian rhythm of blood pressure and heart rate variability among the three groups were compared .Results Patients in MBPS group and non-MBPS group had higher apnea hypopnea index ( AHI, P<0.01 ) , lower mini-mum blood oxygen saturation level ( P<0.01 ) and considerably different circadian rhythm of blood pressure compared with the control guoup .Patients in MBPS group had much higher AHI ( P<0.05 ) and further lower minimum blood oxygen saturation level ( P<0.05 ) , and includ-ed more patients with non-dipper hypertention compared to non-MBPS group ( P<0.05 ) .Re-garding heart rate variability , low-frequency ( LF ) , LF/HF were higher ( P <0.05 ) , while high-frequency (HF), SDNN, PNN50, HRVI were lower(P<0.05).Moreover, other pa-rameters in these two groups were also different in numerus but not in statistics ( P>0.05 ) . Conclusion Patients with MBPS have higher AHI and lower minimum blood oxygen saturation level , comprise more patients with non-dipper hypertention , suffer from more serious damage to autonomic nerves and are more prone to cardiac and cerebrovascular accident .