摘要
目的:应用便携式设备筛查边远藏区住院高血压患者合并睡眠呼吸暂停的情况,并探讨其相关影响。方法:选取2017年12月至2018年5月在四川省得荣县医院住院的高血压病患者76名,通过含心肺耦合及血氧、呼吸气流监测的便携式可穿戴设备记录整晚氧饱和度、呼吸暂停低通气指数(AHI)、氧减指数(ODI)、心率、睡眠结构,并完善动态血压监测,评测Epworth嗜睡评分(ESS)。比较不同血压水平患者的睡眠状况,比较不同AHI水平高血压患者的临床指标差异及睡眠状态差异。结果:其中72.37%住院高血压患者合并睡眠呼吸暂停,高血压3级患者较高血压1级患者睡眠总时间更短[(333.55±43.04)(min) vs.(383.80±31.03)(min),P=0.005];高血压3级患者(AHI)、(ODI)、缺氧时间百分比(TD90)均高于高血压1级组,夜间最低氧饱和度(LnSpO2)低于高血压2级组,总睡眠时间(TST)低于高血压1级与高血压2级组,差异具有统计学意义(P <00.05);高血压3级患者中,可见重度睡眠呼吸暂停低通气综合征(SAHS)组的患者次日收缩压(SBP)、夜间最高SBP、夜间最高舒张压(DBP)均高于非SAHS及轻、中度SAHS组,次日DBP显著高于非SAHS组,差异均具有统计学意义(P <00.05);高血压3级患者中,可见随SAHS严重程度加重,LnSpO2、TST、睡眠效率、REM期睡眠而减少,而觉醒次数、NREM1期睡眠显著增加,差异均具有统计学意义(P <0.05)。结论:边远藏区住院高血压患者中较多合并睡眠呼吸暂停,且睡眠呼吸暂停严重程度与患者夜间血压波动、晨间血压控制欠佳、睡眠质量低下有关,值得临床重视。便携式筛查可用于边远藏区开展睡眠呼吸筛查。
Objective To investigate the portable screening for sleep apnea/hypopnea syndrome （SAHS） in hos-pitalized hypertensive patients in the remote Tibetan area and related influencing factors for SAHS. Methods： A to-tal of 76 hypertensive patients who were hospitalized in the Derong Hospital of Sichuan Province from December2017 to May 2018 were enrolled. A portable wearable device with cardiopulmonary coupling and blood oxygen/respi-ratory airflow monitoring was used to record oxygen saturation, apnea-hypopnea index （AHI）, oxygen desaturation in-dex （ODI）, heart rate, and sleep structure for the whole night. Ambulatory blood pressure monitoring was also per-formed, and Epworth Somnolence Scale （ESS） score was determined. Sleep status was compared between patientswith different blood pressure levels, and clinical indices and sleep status were compared between hypertensive pa-tients with different AHI values. Results： Of all patients, 72.37% had SAHS. The patients with grade 3 hypertensionhad a significantly shorter total sleep time （TST） than those with grade 1 hypertension （333.55±43.04 minutes vs 383.80 ± 31.03 minutes, P = 0.005）; the patients with grade 3 hypertension had significantly higher AHI, ODI, andtime with oxygen saturation below 90% than those with grade 1 hypertension （P 〈 0.05）, a significantly lower mini-mum nighttime oxygen saturation （LnSpO2） than those with grade 2 hypertension （P 〈 0.05）, and a significantly short-er TST than those with grade 1 and 2 hypertension （P 〈 0.05）. In the patients with grade 3 hypertension, the severeSAHS group had significantly higher morning systolic blood pressure （SBP）, maximum nighttime SBP, and maximumnighttime diastolic blood pressure （DBP） than the non-SAHS, mild SAHS, and moderate SAHS groups （P 〈 0.05）and significantly higher morning DBP than the non-SAHS group （P 〈 0.05）. In the patients with grade 3 hyperten-sion, with the increasing severity of SAHS, LnSpO2, TST, sleep efficiency, and ra
作者
李凯
李国平
甲玛
次仁拥忠
胡丽娜
次珠太姆
高航
苏娴
陈锋
Li Kai;Li Guoping;Jia Ma;Ciren Yongzong;Hu Lina;Cizhu Taimu;Gao Hang;Su Xian;Chen Feng(Department of Respiratory of the 3rd People＇s Hospital Chengdu 61003,Sichuan Province China;Derong CountyHospital,Ganzi Perfecture)
出处
《西南医科大学学报》
2018年第5期418-422,共5页
Journal of Southwest Medical University
基金
四川省卫计委项目(2016026)
