论文部分内容阅读
目的探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化。方法入选高血压患者105例,根据多导睡眠仪监测结果分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组36例和高血压合并中、重度 OSAS 组22例。CPAP 或手术治疗前后行24 h 动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系。结果治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%。与单纯高血压组比较,差异有统计学意义(P<0.05)。治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%,38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05)。中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显。结论高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与 OSAS 严重性相关,CPAP 或手术治疗后非杓型明显减少。
Objective To investigate the changes of circadian rhythm of blood pressure before or after continuous positive airway pressure (CPAP) or surgical treatment in patients with hypertension and obstructive sleep apnea syndrome. Methods A total of 105 patients with hypertension were enrolled in this study. According to the results of polysomnography, they were divided into two groups: 47 cases of simple hypertension group, 36 cases of hypertension complicated with mild obstructive sleep apnea syndrome (OSAS) group and 36 cases of hypertension complicated with moderate and severe OSAS Group of 22 cases. Ambulatory blood pressure monitoring was performed 24 h before and after CPAP or surgical treatment. The relationship between sleep breathing parameters and circadian rhythm of blood pressure before and after treatment was compared. Results Before treatment, the diurnal blood pressure of non-dipper type in hypertension group was 23.4%. The diurnal blood pressure in mild and moderate-severe obstructive sleep apnea syndrome group was 47.2% and 59.1% respectively. Compared with simple hypertension group, the difference was statistically significant (P <0.05). After treatment, the diurnal blood pressure in each group showed a non-dipper ratio decreased, respectively, 19.1%, 38.9% and 45.5%, compared with before treatment, the difference was statistically significant (P <0.05). Moderate and severe obstructive sleep apnea syndrome non-dipper blood pressure decreased the most obvious. Conclusion The diurnal blood pressure in patients with hypertension is non-dipper should be considered in combination with sleep apnea syndrome, and diurnal blood pressure changes associated with the severity of OSAS, non-dipper CPAP or surgery significantly reduced.