睡眠呼吸暂停相关心动减缓与晨起血压的关联性研究（英文）

Sleep Apnea associated- Bradycardia and the Morning Blood Pressure Xu Qing Respiratory Dept. Wuhan Union Hospital Background obstructive sleep apnea-hypopnea syndrome OSAHS Apnea Intermittent Hypoxemia Arousal Systemic Hypertention Apnea associated-Bradycardia & Corresponding BP Fluctuations OSAHS Apnea associated-Bradycardia Time(s) Heart rate(bpm ) A pre-event period B hypopnea C post-event recovery period HR Barbara J. Morgan, SLEEP, 1998, 21:737-746. ？ HT HR Vagal nerve Sympathetic nerve ？ BP elevated ？ BP Objective JTo explore the relevance of SA associated-bradycardia to the morning blood pressure J To investigate the role of vagal nervous system plays in OSAHS associated hypertension Subjects J N 104 OSAHS patient J M:F 94:10 J Symptoms J PE： BP J Lab test polysomnography, PSG Methods PSG respiratory inductive plethysmography， RIP D area Respitrace, Ambulatory Monitoring, SensorMedics co. America Parameters involved J Age J Body Mass Index, BMI J Apnea-Hypopnea Index, AHI J Nocturnal Minimum of Arterial Oxygen Saturation, nSaO2 min J Percentage of Dwell Time of Arterial Oxygen Saturation lower than 90%， DT90% J Deviation of Heart Rate, DHR J Blood Pressure MAP=DBP+1/3(SBP-DBP) Results The morning BP vs. Pre-sleep BP Table 1. Comparison of the morning BP to Pre-sleep BP in 104 OSAHS patients x s， (median) Parameter Pre-sleep Morning Morning - pre statistic P value SBP (mm Hg) 123.54 17.76 (120) 128.30 17.89 (125) 4.7910.87 (4) - 4.172 0.000* DBP (mm Hg) 81.96 9.61 (80) 88.58 10.64 (88) 6.62 7.37 (8) - 6.918 0.000* MAP (mm Hg) 95.82 11.50 (93.33) 101.83 12.32 (100) 6.01 7.76 (5.33) - 7.894 0.000* * P 0.01， Wilcoxon Rank sum test， Paired t test * * Comparison between the morning BP and the Pre-sleep BP Figure1. The morning BP (median) is elevated compared to the pre-sleep BP (* P0.01) 0 20 40 60 80 100 120 140 Pre-sleep Morning BP(mm Hg) SBP DBP MAP Construction of hypertension Relevance of DHR to the morning BP Table 2. Correlation test of SA associated DHR and BP pre-/post-sleep SBPbs (mm Hg) DBPbs (mm Hg) SBPas (mm Hg) DBPas (mm Hg) MAPbs (mm Hg) MAPas (mm Hg) DHR (bpm) r 0.085 0.163 0.121 0.214 * 0.141 0.149 P 0.392 0.097 0.223 0.029 0.152 0.130 * P 0.05， simple correlation analysis； rank correlation analysis. Relevance of DHR to the morning DBP DBP: diastolic blood pressure Morning DBP Figure 2. DHR is positive correlated with the morning diastolic blood pressure (r =0.214,P0.05). DHR (bpm) Relevance of DHR to the morning HT Table 3. Risk factors of hypertension by Logistic analysis in OSAHS patients Dependent variable Risk factor OR 95% CI c 2 P SHTas BMI 1.056 1.007 1.109 4.95 0.026 DHR 1.253 1.057 1.486 6.737 0.009 Age 1.126 1.037 1.222 7.964 0.005 DHTas BMI 1.244 1.076 1.439 8.708 0.003* * P 0.01, P 0.05， SHTas: Systolic hypertension after sleep, the Morning SBP 140 mmHg, DHTas: diastolic hypertension after sleep , the Morning DBP90 mmHg ,Age、 BMI、 AHI、 nSaO2%min 、 DT90% and DHR as independent variable. Summary J The morning DBP is elevated remarkably in OSAHS patients compared with the SBP J SA associated-bradycardia is correlated with the morning diastolic blood pressure J The amplitude of bradyc