阻塞性睡眠呼吸暂停低通气综合征对青年患者血压的影响

Hypertension in young patients with obstructive sleep apnea hypopnea syndrome

摘要:

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对青年患者血压的影响。方法 选取1999年1月~2011年6月在我院行睡眠监测的1469例青年患者，按2009年中华医学会耳鼻咽喉头颈外科学分会咽喉学组制定的诊断标准，将患者按呼吸暂停低通气指数（AHI）分为11个组，分别统计各组OSAHS伴发高血压病的例数，并进行列联表分析。分析各组患者年龄、体重指数(BMI)、AHI、最低血氧饱和度（LSaO2）与高血压的相关性。结果①1469例患者中，1188例确诊为OSAHS；557例（46.9%）患者伴发高血压，其中301例（54.5%）为单纯性舒张期高血压(isolated diastolic hypertension, IDH),233例（42.2%）是双相高血压(systolodiastolic hypertension, SDH)。②年龄、AHI、BMI与舒张期血压和收缩期血压呈正相关（r=0.156、0.289、0.299；r=0.168、0.333、0.255,P<0.01）, LSaO2与舒张期血压和收缩期血压呈负相关（r=-0.282,-0.307,P<0.01）并且都是高血压发生的独立相关因素。③组2与组3，组4与组5,组6与组10,其高血压病发率无明显差异(χ2=1.361,χ2=0.668, χ2=1.186,P>0.05)。组1与组2，组2、3与组4，组4、5与组7，组11与其他各组之间高血压病发率存在明显差异（χ2=2.251,χ2=9.883, χ2=4.136, χ2=4.672, P<0.05）。结论青年OSAHS对血压，尤其是舒张期血压产生明显影响，年龄、AHI、BMI、LSaO2可能是高血压的独立相关因素。

Abstract:

Objective To explore the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on blood pressure in young patients.MethodsThere were 1469 young patients with suspected OSAHS underwent polysomnography (PSG) in our hospital from Jan 1999 to June 2011. The age of the patients ranged from 18 to 45 years. All the patients were divided into 11 groups according to the sleep apnea hypopnea index (AHI). Group 1∶AHI＜5, group 2∶5≤AHI＜15, group 3∶15≤AHI＜30, group 4∶30≤AHI＜40, group 5∶40≤AHI＜50, group 6∶50≤AHI＜60, group 7∶60≤AHI＜70, group 8∶70≤AHI＜80, group 9∶80≤AHI＜90, group 10∶90≤AHI＜100, and group 11∶AHI≥100. Incidences of hypertension across groups were compared with crosstabs method. The correlations between diastolic/systolic blood pressure and patients’ age, AHI, body mass index (BMI), the lowest oxygen saturation (LSaO2) were analyzed.Results① Of all the 1469 patients, OSAHS was confirmed by PSG in 1188. Of the 1188 OSAHS patients, hypertension was detected in 557 (46.9%), including isolated diastolic hypertension in 301 cases (54.8%, 301/557) and systolicdiastolic hypertension in 233 (42.2%, 233/557). ② The age, AHI, BMI, LSaO2 and systolic blood pressure were positively correlated with diastolic blood pressure (r=0.156, 0.289, 0.299, 0.333; P<0.01, respectively), and there were negative correlations between LSaO2, systolic blood pressure and diastolic blood pressure (r=-0.282, -0.307; P<0.01, respectively). They were all independent risk factors for hypertension. ③No statistically significant differences of hypertension incidence were found between group 2 and group 3, group 4 and group 5, groups 6 to 10 (χ2=1.361, 0.668, 1.186; P>0.05, respectively). But there were four cutoff points at the AHI of 5, 30, 50 and 100.ConclusionsOSAHS may affect blood pressure in young patients, especially their diastolic blood pressure. The age, AHI, BMI and LSaO2 may be independent risk factors in hypertension of young OSAHS patients.