CAJ | 학술논문

目的：分析阻塞性睡眠呼吸暂停(OSA)患者的高血压患病率，并分析其血压与呼吸通气功能指标的关系。方法选取3607例OSA患者，根据呼吸暂停低通气指数（AHI）将患者分为4组：对照组（AHI<5,354例）、OSA轻度组（5≤AHI<15,658例）、中度组（15≤AHI<30,753例）、重度组（AHI≥30,1842例）。测量入组患者4个时间点（日间、睡前、夜间、晨起）的血压值，计算夜间与日间平均血压比值(RN/D)、晨起与睡前平均血压比值(RM/E)。比较4组的一般指标、高血压患病率、4个时间点的平均血压（MBP）值等，分析MBP与AHI、最低血氧饱和度（LSaO2）的相关性。结果 OSA轻（34.65%）、中（39.04%）、重度组（55.37%）的高血压患病率均高于对照组（22.32%），重度组的高血压患病率高于轻、中度组(均P<0.05)。对于日间及睡前MBP，OSA轻、中、重度组均高于对照组，OSA重度组高于轻、中度组；对于夜间及晨起MBP，重度组＞中度组＞轻度组＞对照组（均P＜0.05）。日间、睡前、夜间、晨起的MBP值均随AHI增加而升高。RN/D及RM/E均随疾病严重度增加而升高。日间血压与AHI、LSaO2显著相关(收缩压, r分别为0.195和-0.206；舒张压，r分别为0.248和-0.251, P<0.01)。随着AHI的增加，日间MBP值逐渐增高；当AHI达到61~65区间之后，日间MBP值通常不再增高或略有降低。结论 OSA患者夜间和晨起血压明显升高，失去正常的昼夜节律。OSA是高血压的独立危险因素。
목적：분석조새성수면호흡잠정(OSA)환자적고혈압환병솔，병분석기혈압여호흡통기공능지표적관계。방법선취3607례OSA환자，근거호흡잠정저통기지수（AHI）장환자분위4조：대조조（AHI<5,354례）、OSA경도조（5≤AHI<15,658례）、중도조（15≤AHI<30,753례）、중도조（AHI≥30,1842례）。측량입조환자4개시간점（일간、수전、야간、신기）적혈압치，계산야간여일간평균혈압비치(RN/D)、신기여수전평균혈압비치(RM/E)。비교4조적일반지표、고혈압환병솔、4개시간점적평균혈압（MBP）치등，분석MBP여AHI、최저혈양포화도（LSaO2）적상관성。결과 OSA경（34.65%）、중（39.04%）、중도조（55.37%）적고혈압환병솔균고우대조조（22.32%），중도조적고혈압환병솔고우경、중도조(균P<0.05)。대우일간급수전MBP，OSA경、중、중도조균고우대조조，OSA중도조고우경、중도조；대우야간급신기MBP，중도조＞중도조＞경도조＞대조조（균P＜0.05）。일간、수전、야간、신기적MBP치균수AHI증가이승고。RN/D급RM/E균수질병엄중도증가이승고。일간혈압여AHI、LSaO2현저상관(수축압, r분별위0.195화-0.206；서장압，r분별위0.248화-0.251, P<0.01)。수착AHI적증가，일간MBP치축점증고；당AHI체도61~65구간지후，일간MBP치통상불재증고혹략유강저。결론 OSA환자야간화신기혈압명현승고，실거정상적주야절률。OSA시고혈압적독립위험인소。
Objective To investigate the prevalence of hypertension in patients with obstructive sleep apnea hypopnea syndrome (OSA) and the relationship between blood pressure (BP) with respiratory ventilation function. Methods Patients with OSA (n=3 607) were included in this study and divided into 4 groups based on their apnea-hypopnea index (AHI) scores:control group (control, n=354) with AHI<5;mild OSAHS (mild, n=658) with 5≤AHI<15;moderate OSAHS (moder?ate, n=753) with 15≤AHI<30;and severe OSA (severe, n=1 842) with AHI≥30. BP were measured at 4 time points (daytime, evening, midnight, and morning). The midnight/ daytime average BP (RN/D) and morning/evening average BP (RM/E) ratios were calculated. Finally, the general profiles, prevalence of hypertension and average BP of 4 time points were compared among 4 groups. The correlations of MBP with AHI and LSaO2 were also analyzed. Results The prevalence of hypertension as well as MBP at daytime and in the morning in the mild group (34.65%), moderate group (39.04%) and severe group (55.37%) were all higher than that in control group (22.32%)(all P<0.05). The prevalence of hypertension as well as MBP at daytime and in the morning were both higher in severe group than those in mild and moderate groups. MPB in the evening and at midnight was higher in severe group than that in moderate group than that in mild group than in control group (P<0.05). Average MBP of all four time points rise with increasing AHI (all P<0.05). The ratios of nighttime to daytime MBP (RN/D) and of morning to evening MBP (RM/E) increased with the severity of the illness (F=9.821, 18.957;P<0.001). The day? time BP correlated well with AHI and lowest oxygen saturation (LSaO2;systolic BP, r=0.195,-0.206;diastolic BP, r=0.248,-0.251, P<0.01). Daytime MBP increased gradually with increasing AHI until MPB reached 61-65, at which point it either plateaued or dropped slightly. Conclusion OSA patients have a significant increase in midnight and morning BP and lose normal BP nycterohemeral rhythm. OSA is an independent risk factor for hypertension.