摘要
目的:观察睡眠呼吸暂停(OSA)患者睡眠时血压的动态变化,探讨无创正压通气(PAP)治疗对OSA患者血压的影响。方法:前瞻性队列研究。选取2017年5月至2019年5月就诊于首都医科大学附属北京朝阳医院呼吸与危重症医学科睡眠中心的睡眠障碍患者。受试者完成整夜多导睡眠图监测及动态脉搏传导时间的血压监测,并于次日压力滴定行PAP治疗时进行动态血压监测。比较PAP治疗前后OSA患者血压的变化。结果:本研究共纳入80例OSA受试者,伴夜间血压升高的受试者,呼吸暂停低通气指数大于无夜间血压升高的受试者;PAP治疗后OSA患者快速眼球运动睡眠期平均收缩压[125.50(24.00)mmHg](1 mmHg=0.133 kPa)较治疗前[124.00(21.75)mmHg]显著下降(Z=-2.926,P=0.003)。PAP治疗后患者峰值血压[182.00(55.00)mmHg]较治疗前[158.00(31.50)mmHg]显著下降(Z=-5.387,P<0.001)。且PAP治疗后OSA患者收缩压增高的次数较治疗前显著降低。结论:PAP治疗可以稳定OSA患者夜间血压的异常波动,降低快速眼球运动期睡眠平均收缩压,降低重度OSA患者的平均收缩压及平均动脉压,平均收缩压下降幅度与收缩压峰值呈正相关,平均动脉压下降幅度与舒张压峰值呈正相关。且PAP降低单纯夜间高血压的效果更显著。
Objective To observed the changes of ambulatory blood pressure in obstructive sleep apnea(OSA)patients,and to explore the effect of positive airway pressure(PAP)on blood pressure in OSA patients.Methods This was a prospective research.Subjects in the study were recruited in Sleep Center of Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital affiliated to Capital Medical University from May 2017 to May 2019.All subjects underwent polysomnography and ambulatory blood pressure monitoring by pulse transit time,following PAP treatment.Results Eighty subjects were in final analysis.Apnea hypopnea index were found to be higher in the subjects with elevated nocturnal BP than patients with normal BP.With PAP treatment,the mean systolic blood pressure(SBP)in rapid eye movement(REM)sleep of the subjects decreased from 125.50(24.00)mmHg(1 mmHg=0.133 kPa)to 124.00(21.75)mmHg,(Z=-2.926,P=0.003).The peak BP were also significantly decreased than baseline[182.00(55.00)mmHg vs 158.00(31.50)mmHg,Z=-5.387,P<0.01].The frequency of high blood pressure was significantly lowered after PAP treatment.Conclusions PAP treatment can stabilize the blood pressure of OSA patients.For severe OSA patients with pure nocturnal hypertension,PAP treatment leads to a reduction in MAP.
作者
赵智玲
孙海燕
孙婉璐
郭兮恒
Zhao Zhiling;Sun Haiyan;Sun Wanlu;Guo Xiheng(Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)
出处
《国际呼吸杂志》
2021年第16期1206-1211,共6页
International Journal of Respiration
基金
国家重点研发计划项目(2016YFC1304403)。
