持续气道正压通气对OSAHS合并不同血压昼夜节律的高血压病患者夜间血压的影响被引量：7

Effect of continuous positive airway pressure on nocturnal blood pressure in patients complicated with obstructive sleep apnea-hypopnea syndrome and different circadian rhythms of hypertension

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摘要目的分析持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并不同血压昼夜节律的高血压病患者夜间血压的影响。方法选择2020年1月至2021年4月在南京医科大学附属淮安第一医院睡眠医学中心行多导睡眠图(PSG)监测并符合本研究入组标准的61例OSAHS患者作为研究对象。在PSG监测时同步对其行夜间连续无创血压及心率变异性监测。采用频域分析方法,以低频率/高频率来间接反映交感神经活性。根据夜间收缩压下降率分为:正常昼夜节律组(夜间血压下降率≥10%),昼夜节律减弱组(夜间血压下降率为0~10%),夜间血压增高组(夜间血压下降率≤0)。分析比较组内及组间CPAP治疗前后的睡眠呼吸紊乱参数,血压参数,交感神经活性等。通过多元线性回归方程分析CPAP降压作用的影响因素。结果三组间的睡前收缩压,OSAHS疾病严重程度,嗜睡评分,入睡前清醒期交感神经活性等基线资料差异无统计学意义。与基线相比,CPAP治疗后的整体睡眠期血压水平出现了微弱的下降[收缩压下降4.6 mmHg(1 mmHg=0.133 kPa),舒张压下降2.4 mmHg;均P<0.001]。亚组分析发现,夜间血压增高组收缩压较基线值平均下降11.1 mmHg,舒张压下降4.9 mmHg(均P<0.001),而正常昼夜节律组及昼夜节律减弱组的血压水平在CPAP干预前后差异无统计学意义(均P>0.05)。另外,三组睡前清醒期交感神经活性无差异,而睡眠期交感神经活性呈递增趋势。夜间血压增高组CPAP干预后的睡眠期交感神经活性较基线水平降低(P<0.001),而其他亚组在干预前后无差异。在控制年龄等基线资料后,回归方程显示,睡眠期血压下降幅度与夜间血压增高型血压节律(收缩压:β=0.548,P=0.002;舒张压:β=0.454,P=0.013)及夜间平均脉氧饱和度的改善程度密切相关(收缩压:β=0.410,P=0.046),而与OSAHS疾病严重程度,日间嗜睡,基线血压值均无相关性。结论对于合并高血压病的中重度OSAHS患者,夜间血压增高型血压节律是预判其可从CPAP治疗中获得降压作用的有效指标。 Objectives To analysis the effect of continuous positive airway pressure(CPAP)on nocturnal blood pressure in patients complicated with obstructive sleep apnea-hypopnea syndrome(OSAHS)and different circadian rhythms of hypertension.Methods A total of 61 eligible patients were monitored by overnight polysomnography(PSG)at the Sleep Center of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2020 and April 2021.During the period of PSG monitoring,continuous non-invasive blood pressure(BP)and heart rate variability(HRV)were monitored simultaneously.Frequency domain analysis was used to measure HRV and low/high frequency was used to indirectly reflect sympathetic activity.According to the nighttime systolic BP decrease rate,patients were divided into three groups:dipper pattern(descent rate≥10%),non-dipper pattern(descent rate was less than 10%but higher than 0)and reverse dipper pattern(descent rate≤0).The PSG parameters,BP data as well as sympathetic activity etc.were compared within and among groups before and after CPAP treatment.Multiple linear regression analyses were used to explore the influencing factors of antihypertensive effect of CPAP.Results There were no significant differences in awake systolic BP(SBP)values,the severity of OSAHS,ESS scores,awake sympathetic activity and the other baseline data among the three groups.After CPAP treatment,the mean value of asleep BP in entire group showed a modest decline as compared to the baseline values[SBP decreased 4.6 mmHg(1 mmHg=0.133 kPa);diastolic blood pressure(DBP)decreased 2.4 mmHg,both P<0.001].Subgroup analysis showed a significant reduction in asleep SBP of 11.1 mmHg and DBP of 4.9 mmHg(both P<0.001)in reverse dipper group,respectively,compared with the baseline values.While in dipper and non-dipper group,there were no significant differences before and after CPAP treatment in terms of BP(both P>0.05).In addition,there was no difference in awake sympathetic activity among three groups,while sleep sympathetic activity showed a gradual increasing trend.Sleep sympathetic activity decreased significantly from baseline after CPAP treatment in reverse dipper group(P<0.001),while no differences were found in the other two groups before and after treatment.After controlling for baseline data such as age etc.,the line regression model showed that the antihypertensive effect of CPAP was correlated with reverse dipper(SBP:β=0.548,P=0.002;DBP:β=0.454,P=0.013)and the improvement of nocturnal MpO2(SBP:β=0.410,P=0.046),but not with the severity of OSAHS,daytime sleepiness,or baseline BP values.Conclusion For patients with moderate to severe OSAHS and hypertension,reverse dipper is an effective indicator to predict the antihypertensive effect of CPAP therapy.

作者杨婷王娜娜孙兵徐靖黄茂孟自力 Yang Ting;Wang Nana;Sun Bing;Xu Jing;Huang Mao;Meng Zili(Department of Respiratory and Critical Care Medicine,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区南京医科大学附属淮安第一医院呼吸与危重症医学科南京医科大学第一附属医院呼吸与危重症医学科

出处《中华健康管理学杂志》 CAS CSCD 2022年第5期325-330,共6页 Chinese Journal of Health Management

基金国家自然科学基金(81900084)。

关键词睡眠呼吸暂停阻塞性持续气道正压通气血压昼夜节律高血压 Sleep apnea,obstructive Continuous positive airway pressure Circadian rhythm of blood pressure Hypertension

分类号 R544.1 [医药卫生—心血管疾病] R766 [医药卫生—耳鼻咽喉科]

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1潘伟琦,胡荣.2017美国高血压新指南的变化及对我国高血压管理的思考[J].中华健康管理学杂志,2018,12(3):278-282. 被引量：5
2杜丽娜,任蓉,谭璐,李桃美,雷飞,唐向东,杨玲慧.阻塞性睡眠呼吸暂停综合征患者日间嗜睡与高血压的关系[J].中华医学杂志,2016,96(42):3370-3374. 被引量：18

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