伴及不伴OSA高血压患者的血压变异性和OSA相关性研究(1)
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摘要：目的 研究伴或不伴睡眠呼吸暂停(obstructive sleep apnea,OSA)高血压患者的血压变异性和OSA的相关性。方法 纳入阴虚阳亢型轻中度高血压患者90例，对患者行便携式睡眠仪监测、24 h动态血压(ABPM)监测。观察患者血压的均值、变异性，及昼夜节律和OSA的关系；采用多元逐步回归法分析OSA和血压的关系。结果 与不伴OSA的高血压患者相比，伴OSA患者的血压变异性和非杓型血压发生率明显增高，夜间血压下降率明显降低(P<0.05)；其中夜间平均收缩压、24 h收缩压血压标准差与睡眠呼吸暂停低通气指数(apnea hypopnea index，AHI)呈正相关，夜间收缩压下降率和AHI呈负相关(P<0.05)。结论 伴OSA患者的血压变异性增高，昼夜节律紊乱。
关键词：高血压；睡眠呼吸暂停；血压变异性
中图分类号：R544.1 R255.3 文献标识码：B 文章编号：1672-1349(2012)01-0012-04
Relationship between Blood Pressure Variability and Obstructive Sleep Apnea in Hypertensive Patients
Chen Yiyu,Zhang Jingchun,Chen Jing,et al // Xiyuan Hospital,China Academy of Chinese Medical Sciences (Beijing 100091)
Abstract:Objectives To analyze the correlation between blood pressure variability(BPV)and obstructive sleep apnea (OSA) in patients (pts) with hypertension.Methods Ninty patients with mild and moderate hypertension and yin-deficiency and yang-hyperactivity syndrome were enrolled.All patients received portable sleep monitoring，24 hours ambulatory blood pressure monitoring (ABPM).The blood pressure mean values,BPV,blood pressure circadian rhythm and OSA were collected and their correlation was analyzed.Results The blood pressure variability and the occurrence of non-dipper hypertension were significantly higher in hypertensive pts with OSA than those without OSA.The night time blood pressure falling rate was significantly lower in pts with OSA than those without OSA(P<0.05).The apnea hypopnea index(AHI) had positive relation with night time systolic blood pressure (SBP) and 24 hour SBP standard deviation(SD),and negative relation with night time SBP falling rate(P<0.05).Conclusion The BPV was increased,and circadian rhythm was out of order in hypertensive pts with OSA.
Key words:hypertension;obstructive sleep apnea;blood pressure variability
高血压与睡眠呼吸暂停(obstructive sleep apnea,OSA)关系密切，OSA是高血压的独立危险因素。约30%原发性高血压患者合并OSA，50%OSA患者存在高血压[1]。多项研究已经证实OSA是独立于年龄、体重、饮食、遗传等的高血压发病因素之一,可以导致高血压的发生。本研究比较了不同程度OSA的高血压患者血压及其变异情况，分析OSA和血压平均值、血压变异性(BPV)及昼夜节律的关系。
1 资料与方法
1.1 诊断标准 高血压诊断标准参照2003年WHO/ISH高血压防治指南[2]，以及2005年《中国高血压防治指南》[3]。中医证候诊断标准参照卫生部2002年《中药新药临床研究指导原则》中高血压阴虚阳亢证标准[4]。睡眠呼吸暂停低通气OSA诊断标准 ......
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