中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
9期
751-755
,共5页
韩瑞梅%李南方%严治涛%汪迎春%张丽丽%毕云伟%程维平
韓瑞梅%李南方%嚴治濤%汪迎春%張麗麗%畢雲偉%程維平
한서매%리남방%엄치도%왕영춘%장려려%필운위%정유평
睡眠呼吸暂停,阻塞性%高血压%血压%昼夜节律
睡眠呼吸暫停,阻塞性%高血壓%血壓%晝夜節律
수면호흡잠정,조새성%고혈압%혈압%주야절률
Sleep apnea,obstructive%Hypertension%Blood pressure%Circadian rhythm
目的 探讨肥胖、低氧与交感神经活性增加等多种因素对阻塞性睡眠呼吸暂停相关性高血压患者昼夜血压节律变化的影响.方法 对诉有睡眠时打鼾、白天嗜睡、其他原因不能解释的唇舌发绀、难治性高血压或伴有不明原因的高血红蛋白血症的436例高血压住院患者,行多导睡眠监测(PSG),根据睡眠呼吸暂停低通气指数(AHI),将入选者分为高血压合并轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)组131例(5≤AHI＜ 15)、高血压合并中度OSAHS组95例(15≤AHI＜ 30)、高血压合并重度OSAHS组95例(AHI≥30),以及单纯高血压对照组115例(AHI ＜5).对比四组患者的动态血压(ABPM)、PSG、尿离子、24 h尿香草扁桃酸(VMA)各参数,采用因子分析方法提取影响血压节律变化的公因子,多元线性回归分析影响血压节律变化的因素.结果 四组患者年龄、颈围和腹围差异均有统计学意义(均P＜0.001).重度组24 h平均收缩压(24 h SBP)[(137.0±16.8)mm Hg比(131.3±11.9)mm Hg、(131.3±13.2)mm Hg(1 mm Hg =0.133 kPa)]、日间平均收缩压[(140.8±16.8)mm Hg比(135.7±11.9)mm Hg、(135.3±13.5) mm Hg]和夜间平均收缩压[(130.9±17.0) mm Hg比(124.5 ±14.0)mm Hg、(124.3±13.2)mm Hg]均高于对照组、轻度组(均P＜0.01),4组间夜间收缩压下降百分率(△SBP％)、夜间舒张压下降百分率(△DBP％)差异无统计学意义(均P＞0.05).因子分析纳人可能影响血压节律变化的因素,共提取5个公因子:OSAHS、体质量、生活行为习惯、尿离子、年龄病程因子；多元线性回归显示OSAHS因子与△SBP％ (β=-0.128,P＜0.01)和△DBP％(β=-0.126,P＜0.01)相关,△SBP％的影响因素依次为年龄病程＞OSAHS＞体质量因子(分别β=-0.148,P=0.002;β=-0.128,P=0.007；β=0.099,P=0.035),△DBP％的影响因素依次为OSAHS＞年龄病程＞体质量因子(分别β=-0.126,P=0.008;β=-0.105,P=0.026；β=0.097,P =0.042).结论 在阻塞性睡眠呼吸暂停相关性高血压患者中,OSAHS、年龄病程和体质量因素可能是导致该人群血压节律异常变化的主要因素.
目的 探討肥胖、低氧與交感神經活性增加等多種因素對阻塞性睡眠呼吸暫停相關性高血壓患者晝夜血壓節律變化的影響.方法 對訴有睡眠時打鼾、白天嗜睡、其他原因不能解釋的脣舌髮紺、難治性高血壓或伴有不明原因的高血紅蛋白血癥的436例高血壓住院患者,行多導睡眠鑑測(PSG),根據睡眠呼吸暫停低通氣指數(AHI),將入選者分為高血壓閤併輕度阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)組131例(5≤AHI＜ 15)、高血壓閤併中度OSAHS組95例(15≤AHI＜ 30)、高血壓閤併重度OSAHS組95例(AHI≥30),以及單純高血壓對照組115例(AHI ＜5).對比四組患者的動態血壓(ABPM)、PSG、尿離子、24 h尿香草扁桃痠(VMA)各參數,採用因子分析方法提取影響血壓節律變化的公因子,多元線性迴歸分析影響血壓節律變化的因素.結果 四組患者年齡、頸圍和腹圍差異均有統計學意義(均P＜0.001).重度組24 h平均收縮壓(24 h SBP)[(137.0±16.8)mm Hg比(131.3±11.9)mm Hg、(131.3±13.2)mm Hg(1 mm Hg =0.133 kPa)]、日間平均收縮壓[(140.8±16.8)mm Hg比(135.7±11.9)mm Hg、(135.3±13.5) mm Hg]和夜間平均收縮壓[(130.9±17.0) mm Hg比(124.5 ±14.0)mm Hg、(124.3±13.2)mm Hg]均高于對照組、輕度組(均P＜0.01),4組間夜間收縮壓下降百分率(△SBP％)、夜間舒張壓下降百分率(△DBP％)差異無統計學意義(均P＞0.05).因子分析納人可能影響血壓節律變化的因素,共提取5箇公因子:OSAHS、體質量、生活行為習慣、尿離子、年齡病程因子；多元線性迴歸顯示OSAHS因子與△SBP％ (β=-0.128,P＜0.01)和△DBP％(β=-0.126,P＜0.01)相關,△SBP％的影響因素依次為年齡病程＞OSAHS＞體質量因子(分彆β=-0.148,P=0.002;β=-0.128,P=0.007；β=0.099,P=0.035),△DBP％的影響因素依次為OSAHS＞年齡病程＞體質量因子(分彆β=-0.126,P=0.008;β=-0.105,P=0.026；β=0.097,P =0.042).結論 在阻塞性睡眠呼吸暫停相關性高血壓患者中,OSAHS、年齡病程和體質量因素可能是導緻該人群血壓節律異常變化的主要因素.
목적 탐토비반、저양여교감신경활성증가등다충인소대조새성수면호흡잠정상관성고혈압환자주야혈압절률변화적영향.방법 대소유수면시타한、백천기수、기타원인불능해석적진설발감、난치성고혈압혹반유불명원인적고혈홍단백혈증적436례고혈압주원환자,행다도수면감측(PSG),근거수면호흡잠정저통기지수(AHI),장입선자분위고혈압합병경도조새성수면호흡잠정저통기종합정(OSAHS)조131례(5≤AHI＜ 15)、고혈압합병중도OSAHS조95례(15≤AHI＜ 30)、고혈압합병중도OSAHS조95례(AHI≥30),이급단순고혈압대조조115례(AHI ＜5).대비사조환자적동태혈압(ABPM)、PSG、뇨리자、24 h뇨향초편도산(VMA)각삼수,채용인자분석방법제취영향혈압절률변화적공인자,다원선성회귀분석영향혈압절률변화적인소.결과 사조환자년령、경위화복위차이균유통계학의의(균P＜0.001).중도조24 h평균수축압(24 h SBP)[(137.0±16.8)mm Hg비(131.3±11.9)mm Hg、(131.3±13.2)mm Hg(1 mm Hg =0.133 kPa)]、일간평균수축압[(140.8±16.8)mm Hg비(135.7±11.9)mm Hg、(135.3±13.5) mm Hg]화야간평균수축압[(130.9±17.0) mm Hg비(124.5 ±14.0)mm Hg、(124.3±13.2)mm Hg]균고우대조조、경도조(균P＜0.01),4조간야간수축압하강백분솔(△SBP％)、야간서장압하강백분솔(△DBP％)차이무통계학의의(균P＞0.05).인자분석납인가능영향혈압절률변화적인소,공제취5개공인자:OSAHS、체질량、생활행위습관、뇨리자、년령병정인자；다원선성회귀현시OSAHS인자여△SBP％ (β=-0.128,P＜0.01)화△DBP％(β=-0.126,P＜0.01)상관,△SBP％적영향인소의차위년령병정＞OSAHS＞체질량인자(분별β=-0.148,P=0.002;β=-0.128,P=0.007；β=0.099,P=0.035),△DBP％적영향인소의차위OSAHS＞년령병정＞체질량인자(분별β=-0.126,P=0.008;β=-0.105,P=0.026；β=0.097,P =0.042).결론 재조새성수면호흡잠정상관성고혈압환자중,OSAHS、년령병정화체질량인소가능시도치해인군혈압절률이상변화적주요인소.
Objective To investigate the effect of obesity,arousal,hypoxia and sympathetic activation on the circadian blood pressure of hypertensive patients with obstructive sleep apnea-hypopnea syndrome.Methods Polysomnography (PSG) was performed in 436 hypertensive patients complaining of snoring,daytime sleepiness,lips cyanosis,hyperhemoglobinemia of unknown etiology,or with refractory hypertension.Hypertensive subjects were divided into four groups according to apnea-hypopnea index (AHI):hypertensive with mild obstructive sleep apnea-hypopnea syndrome (OSAHS) (n =131),hypertensive with moderate OSAHS (n =95),hypertensive with severe OSAHS (n =95) and hypertensive without OSAHS as control group (n =115).The ambulatory blood pressure monitoring (ABPM),PSG,urine electrolyte,and urine vanillylmandelic acid (VMA) were compared among groups.Factor analysis was employed to identify common factors related to the alterations of circadian blood pressure.Multiple linear regression analysis was used to analyze the influencing factors of the observed variables.Results There were significant differences among groups in age,neck circumference and waist circumference (P ＜ 0.001).In severe group,24 hour average systolic blood pressure (24 hSBP) [(137.0 ± 16.8) mm Hg vs.(131.3 ±11.9) mm Hg,(131.3 ± 13.2) mm Hg (1 mm Hg =0.133 kPa)],daytime systolic blood pressure (daySBP) [(140.8±16.8) mmHgvs.(135.7±11.9) mmHg,(135.3±13.5) mmHg]andnight systolic blood pressure (night-SBP) [(130.9 ±17.0)mm Hg vs.(124.5 ±14.0)mm Hg,(124.3 ±13.2) mm Hg]were significantly higher than those of control or mild OSAS groups (P ＜ 0.01).Factor analysis showed that body mass (BM),life style,urine electrolyte,age and course of disease (ACD) were the common factors influencing circadian blood pressure.OSAHS was correlated with declining percentage of SBP (β =-0.128,P ＜ 0.01) and declining percentage of DBP (β =-0.126,P ＜ 0.01).The contribution according to priority was ACD ＞ OSAHS ＞ BM for declining percentage of SBP(β =-0.148,P =0.002 ;β =-0.128,P =0.007 ;β =0.099,P =0.035),OSAHS ＞ ACD ＞ BM for declining percentage of DBP (β =-0.126,P=0.008;β=-0.105,P =0.026 ;β =0.097,P =0.042).Conclusion OSAHS,ACD and BM are the independent risk factors contributing to the alterations of circadian blood pressure in hypertensive patients with obstructive sleep apnea-hypopnea syndrome.
