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

SleepApneaassociated-Bradycardia

andtheMorningBloodPressure

Backgroundobstructivesleepapnea-hypopneasyndromeOSAHSApneaIntermittentHypoxemiaArousalSystemicHypertentionApneaassociated-Bradycardia

&CorrespondingBPFluctuationsOSAHSApneaassociated-Bradycardia

Time(s)Heartrate(bpm)Apre-eventperiod

Bhypopnea

Cpost-eventrecoveryperiod

HRBarbaraJ.Morgan,SLEEP,

1998,21:737-746.

？HT△HRVagalnerveSympatheticnerve？BPelevated？△BPObjectiveToexploretherelevanceofSAassociated-bradycardiatothemorningbloodpressure

ToinvestigatetheroleofvagalnervoussystemplaysinOSAHSassociatedhypertensionSubjectsN＝104

OSAHS

patient

M:F＝94:10

Symptoms

PE：BP

Labtestpolysomnography,PSGMethodsPSG

respiratoryinductiveplethysmography，RIPDareaRespitrace,AmbulatoryMonitoring,SensorMedicsco.America

ParametersinvolvedAgeBodyMassIndex,BMIApnea-HypopneaIndex,AHINocturnalMinimumofArterialOxygenSaturation,nSaO2％minPercentageofDwellTimeofArterialOxygenSaturationlowerthan90%，DT90%DeviationofHeartRate,DHRBloodPressureMAP=DBP+1/3(SBP-DBP)ResultsThemorningBPvs.Pre-sleepBPTable1.ComparisonofthemorningBPtoPre-sleepBPin104OSAHS

patients

x±s，(median)

ParameterPre-sleepMorningMorning-prestatisticPvalueSBP(mmHg)†123.54±17.76(120)128.30±17.89(125)4.79±10.87(4)-4.1720.000*DBP

(mmHg)†81.96±9.61(80)88.58±10.64(88)6.62±7.37(8)-6.9180.000*MAP(mmHg)‡95.82±11.50(93.33)101.83±12.32(100)6.01±7.76(5.33)-7.8940.000*

*P<0.01，†Wilcoxon

Ranksumtest，‡Pairedt–test***Comparisonbetween

themorningBPandthePre-sleepBPFigure1.ThemorningBP(median)iselevatedcomparedtothepre-sleepBP(*P<0.01)020406080100120140Pre-sleepMorningBP(mmHg)SBPDBPMAPConstructionofhypertensionRelevanceofDHRtothemorningBPTable2.CorrelationtestofSAassociatedDHRandBPpre-/post-sleepSBPbs‡(mmHg)DBPbs‡(mmHg)SBPas‡(mmHg)DBPas‡(mmHg)MAPbs†(mmHg)MAPas†(mmHg)DHR(bpm)r0.0850.1630.1210.214*0.1410.149P0.3920.0970.2230.0290.1520.130*P<0.05，†simplecorrelationanalysis；‡rankcorrelationanalysis.

RelevanceofDHRtothemorningDBPDBP:diastolicbloodpressureMorningDBPFigure2.DHRispositivecorrelatedwiththemorningdiastolicbloodpressure(r=0.214,P<0.05).DHR(bpm)RelevanceofDHRtothemorningHTTable

3.

RiskfactorsofhypertensionbyLogistic

analysisinOSAHS

patientsDependentvariableRiskfactorOR95%CIc2PSHTasBMI1.0561.007~1.1094.950.026DHR1.2531.057~1.4866.7370.009Age1.1261.037~1.2227.9640.005DHTasBMI1.2441.076~1.4398.7080.003**P<0.01,†P<0.05，SHTas:Systolichypertensionaftersleep,theMorningSBP≥140mmHg,DHTas:diastolichypertensionaftersleep,theMorningDBP≥90mmHg,Age、BMI、AHI、nSaO2%min、DT90%

andDHR

asindependentvariable.SummaryThemorningDBPiselevatedremarkably

inOSAHS

patientscomparedwiththeSBPSAassociated-bradycardiaiscorrelatedwiththemorningdiastolicbloodpressureTheamplitudeofbr