摘要
目的:探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者的日间嗜睡与高血压病的共同危险因素。方法:选择2020年1月—2021年2月经南京医科大学附属淮安第一医院睡眠医学中心确诊的OSAHS患者103例作为研究对象。在进行多导睡眠图监测时,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,以低频成分/高频成分(LF/HF)来反映交感/迷走张力的平衡比值。根据Epworth嗜睡量表(ESS)评分及血压水平将受试者分为4组:(1)单纯OSAHS组(30例):ESS评分<10分且血压<140/90 mmHg(1 mmHg=0.133 kPa);(2)OSAHS+高血压病组(23例):ESS评分<10分且血压≥140/90 mmHg;(3)OSAHS+嗜睡组(26例):ESS评分≥10分且血压<140/90 mmHg;(4)OSAHS+嗜睡+高血压病组(24例):ESS评分≥10分且血压≥140/90 mmHg。分析比较各组的临床资料及睡眠呼吸紊乱相关指标,并通过回归方程分析OSAHS患者发生日间嗜睡及高血压病的共同危险因素。结果:OSAHS+嗜睡+高血压病组LF/HF均显著高于其他三组[3.2%(2.6%,4.2%)比1.4%(1.2%,1.6%),2.2%(1.8%,2.9%),2.5%(1.6%,3.1%),均P<0.05],OSAHS+高血压病组及OSAHS+嗜睡组间差异无统计学意义(P=0.779),但均高于单纯OSAHS组(均P<0.05)。与其他睡眠呼吸紊乱指标相比较,LF/HF与夜间脉搏血氧饱和度(SpO_(2))<90%的睡眠时间占比(T90)最为相关(β=0.201,P=0.006)。Pearson相关分析显示LF/HF与ESS评分、睡眠期收缩压水平均显著相关(r=0.536、0.456,均P<0.05)。逻辑回归方程显示LF/HF与OSAHS患者同时罹患日间嗜睡及高血压病密切相关(β=0.164,95%CI:1.018~1.364;P=0.028)。结论:交感迷走失衡是OSAHS患者发生日间嗜睡及高血压病的共同危险因素。
Objectives To investigate the common risk factors for excess daytime sleepiness(EDS)and hypertension in obstructive sleep apnea-hypopnea syndrome(OSAHS)patients.Methods Between January 2020 and February 2021,a total of 103 OSAHS patients diagnosed in the Department of Sleep Medicine Center,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University were enrolled as the study population.During polysomnography(PSG)monitoring,noninvasive continuous blood pressure(BP)and heart rate variability(HRV)were monitored simultaneously.Low/high frequency components(LF/HF)were used to reflect sympathetic-vagal balance in frequency domain analysis.According to Epworth Sleepiness Scale(ESS)and BP levels,patients were divided into four groups:simple OSAHS group(ESS<10 scores and BP<140/90 mmHg,n=30)(1 mmHg=0.133 kPa),OSAHS+hypertension group(ESS<10 scores and BP≥140/90 mmHg,n=23),OSAHS+EDS group(ESS≥10 scores and BP<140/90 mmHg,n=26)and OSAHS+hypertension+EDS group(ESS≥10scores and BP≥140/90 mmHg,n=24).The clinical and PSG parameters were analyzed and compared among the four groups.Regression analyses were used to explore the common causative factors for EDS and hypertension.Results The LF/HF in OSAHS+hypertension+EDS group was significantly higher than the other three groups[3.2%(2.6%,4.2%)vs 1.4%(1.2%,1.6%),2.2%(1.8%,2.9%),2.5%(1.6%,3.1%),all P<0.05].No difference was observed between OSAHS+hypertension group and OSAHS+EDS group(P=0.779),but both higher than simple OSAHS group.The linear regression equation showed that LF/HF was most correlated with the percentage of sleep time with oxygen saturation<90%(T90)as compared to the other parameters of sleep disordered breathing(β=0.201,P=0.006).In addition,Pearson correlation analysis showed that LF/HF was significantly correlated with ESS scores and asleep BP levels(r=0.536,r=0.456,all P<0.05).The logical regression equation showed that LF/HF was a causative risk factor for both EDS and hypertension in OSAHS(β=0.164,95%CI:1.018-1.364,P=0.028).Conclusion The sympathetic-vagal imbalance is a common risk factor for EDS and hypertension in OSAHS patients.
作者
魏桂红
陈炜
黄茂
孟自力
徐靖
Wei Guihong;Chen Wei;Huang Mao;Meng Zili;Xu Jing(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)
出处
《中华健康管理学杂志》
CAS
CSCD
2021年第3期220-225,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
日间嗜睡
高血压病
交感迷走失衡
Sleep apnea,obstructive
Daytime sleepiness
Hypertension
Sympathetic-vagal imbalance
