合并阻塞性睡眠呼吸暂停的高血压患者血压变异性和靶器官损害的研究
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Sleep-apnea related blood-pressure variability and target organ damage in hypertensives
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    摘要:

    目的阻塞性睡眠呼吸暂停(OSA)引发睡眠期间血流动力学变化,增加夜间血压变异性,加重靶器官损害,但这种影响可能受年龄的干扰。方法143例多导睡眠诊断的OSA患者分为3组:<60岁高血压组(62例)、<60岁正常血压组(38例)和>60岁正常血压组(43例),全部进行24h动态血压监测,分析白天和夜间血压变化的标准差(SD)和变异系数(CV),在排除年龄干扰因素外,判断OSA对血压变异性的影响及靶器官的损害情况。结果与<60岁正常血压组相比,高血压组白天和夜间血压变化SD明显增加,白天收缩压18.5和10.6mmHg(P<0.05);白天舒张压13.8和10.6mmHg(P<0.05);夜间收缩压20.5和12.6mmHg(P<0.01);夜间舒张压17.8和12.6mmHg(P<0.01)。血压CV也明显增加,白天收缩压0.119和0.078(P<0.01);白天舒张压0.139和0.118(P<0.05);夜间收缩压0.137和0.111(P<0.01);夜间舒张压0.195和0.177(P<0.01)。与>60岁正常血压组相比,高血压组白天和夜间血压变化SD明显增加,白天收缩压18.5和13.3mmHg(P<0.05);白天舒张压13.8和10.2mmHg(P<0.05);夜间收缩压20.5和15.2mmHg(P<0.01);夜间舒张压17.8和14.2mmHg(P<0.01)。白天收缩压CV增加(0.119和0.093;P<0.05);夜间收缩压和舒张压CV增加(0.137和0.123;P<0.01;0.195和0.179;P<0.05)。与<60岁正常血压组相比,>60岁正常血压组白天收缩压CV增加(0.093和0.078;P<0.05)。与<60或>60岁正常血压组相比,高血压组靶器官损害增加(P<0.01)。与<60岁正常血压组相比,>60岁正常血压组靶器官损害也增加(P<0.05)。结论尽管年龄可能影响血压变异性,但是OSA对血压变异性的影响明显超过年龄的作用,并加重靶器官损害。因此,对于合并OSA的老年高血压患者更应给予足够重视。

    Abstract:

    Objective Obstructive sleep apnea(OSA) induces marked hemodynamic fluctuations that might be deleterious to the cardiovascular system.The influence of OSA and aging on short-term blood pressure(BP) variability in OSA patients was investigated.The standard deviation(SD) and coefficient of variation(CV) of BP during daytime and nighttime were assessed to estimate short-term BP variability.Methods Totally 143 subjects with newly-diagnosed untreated OSA were categorized into three groups: subjects aged <60 years with untreated hypertension(n=62);normotensive subjects aged<60 years(n=38);and normotension subjects aged>60 years(n=43).Twenty four-hour BP was recorded after polysomnography.Results The SD of systolic or diastolic BP during daytime and nighttime was significantly greater in hypertensives than in normotensives aged<60 years(18.5 vs 10.6mmHg,P<0.05,and 13.8 vs 10.6mmHg,P<0.05,daytime;20.5 vs 12.6mmHg,P<0.01 and 17.8 vs 12.6mmHg,P<0.01,nighttime),as was the CV of systolic or diastolic BP during daytime and nighttime(0.119 vs 0.078,P<0.01 and 0.139 vs 0.118,P<0.05,daytime;0.137 vs 0.111,P<0.01 and 0.195 vs 0.177,P<0.01,nighttime);compared to the group of normotensive aged>60 years,the SD of systolic or diastolic BP variations during daytime and nighttime were higher in hypertensives(18.5 vs 13.3mmHg,P<0.05 and 13.8 vs 10.2mmHg,P<0.05,daytime;20.5 vs 15.2mmHg,P<0.01 and 17.8 vs 14.2mmHg,P<0.01,nighttime),and as was the CV of systolic BP during daytime(0.119 vs 0.093,P<0.05) and systolic or diastolic BP during nighttime(0.137 vs 0.123,P<0.01 and 0.195 vs 0.179,P<0.01).Daytime systolic BP CV was increased in normotensive elderly patients than in patients aged<60years(0.093 vs 0.078,P<0.05).As to the target organ damage,hypertensive group had higher rate than the two normotensive groups(P<0.05),and the elderly group had more target organ damage than the patients aged<60years(P<0.05).Conclusion Systemic hypertension is associated with a more severe exacerbation of short-term variability and higher rate of target organ damage in the OSA patients.

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李莉 倪如旸.合并阻塞性睡眠呼吸暂停的高血压患者血压变异性和靶器官损害的研究[J].中华老年多器官疾病杂志,2009,8(4):303~306

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