氧降和复氧速率对阻塞性睡眠呼吸暂停患者昼夜血压的影响

doi:10.13481/j.1671-587X.20210426

摘要/Abstract

摘要： 目的

探讨阻塞性睡眠呼吸暂停（OSA）患者睡眠中氧降速率和复氧速率对患者昼夜间血压的影响，并阐明其作用机制。

方法

收集106例OSA患者整夜多导睡眠呼吸监测资料，包括睡眠参数、呼吸事件参数和当天清醒期及睡眠期无创多点连续血压监测资料。根据OSA患者每个呼吸事件的氧降幅度与氧降时间的比值获得氧降速率，同样方法获得复氧速率。根据血压监测结果将患者分为OSA并发高血压组（OSA+HT组，59例）和OSA未并发高血压组（OSA－HT组，47例），分析2组患者氧降速率和复氧速率的差异，分别对所有入组患者进行氧降和复氧速率与白天血压值、夜间血压值以及夜间血压波动性（NBPF）的相关性分析。

结果

OSA+HT组患者氧降速率和复氧速率明显高于OSA－HT组（P<0.01）。氧降速率与患者夜间收缩压、舒张压、平均动脉压及白天舒张压和平均动脉压均呈正相关关系（r=0.311，P=0.001；r =0.245，P=0.011；r=0.308，P=0.001；r=0.203，P=0.037；r =0.219，P=0.024），复氧速率与患者夜间收缩压、舒张压、平均动脉压及白天舒张压和平均动脉压均呈正相关关系（r=0.327，P=0.001；r=0.288，P=0.003；r=0.343，P=0.000；r=0.250，P=0.01；r=0.259，P=0.007）；氧降速率和复氧速率均与OSA患者NBPF呈正相关关系（r=0.595，P<0.01；r=0.646，P<0.01）。

结论

OSA患者间歇性氧降和复氧的损害与其昼夜血压升高有直接关联，氧降与复氧速率的变化是导致OSA患者NBPF的重要因素。

关键词: 氧降速率, 复氧速率, 阻塞性睡眠呼吸暂停, 高血压

Abstract: Objective

To investigate the effect of the speeds of deoxygenation and reoxygenation on the diurnal and nocturnal blood pressure in the obstructive sleep apnea（OSA） patients，and to clarify their mechanisms.

Methods

The information of overnight polysomnography parameters of 106 OSA patients were collected，including sleep parameters and respiratory event parameters，as well as non-invasive multi-point continuous blood pressure monitoring during wakefulness and sleep stages on the monitoring day. The speed of deoxygenation was calculated by the ratio of the latitude value for oxygen desaturation and correspondent duration of desaturation. The reoxygenation speed was calculated similarly. The patients were divided into two groups based on the blood pressure values： OSA complicated with hypertension group （OSA+HT，n=59） and OSA without hypertension group（OSA－HT，n=47）. The differences in the speeds of deoxygenation and reoxygenation were analyzed between two groups.The correlations were respectively analyzed between the speeds of deoxygenation，reoxygenation， the diurnal and nocturnal blood pressure and the nocturnal blood pressure fluctuation（NBPF） for all the OSA patients.

Results

The deoxygenation speed and the reoxygenation speed in OSA + HT group was significantly higher than that in OSA－HT group （P<0.01）；the deoxygenation speed was positively correlated with the nocturnal systolic blood pressure， diastolic blood pressure， mean arterial pressure， diurnal diastolic blood pressure and mean arterial pressure （r=0.311，P=0.001；r=0.245， P= 0.011；r=0.308， P=0.001；r=0.203，P=0.037；r=0.219，P=0.024）， and the reoxygenation speed was positively correlated with the nocturnal systolic blood pressure， diastolic blood pressure， mean arterial pressure，diurnal diastolic blood pressure and mean arterial pressure （r=0.327，P=0.001；r=0.288，P=0.003；r=0.343，P=0.000；r=0.250，P=0.01；r=0.259，P=0.007）； there was a positive correlation between both of the deoxygenation speed and the reoxygenation speed and NBPF（r=0.595，P<0.01；r=0.646， P=<0.01）.

Conclusion

The damage of deoxygenation and reoxygenation in the OSA patients is directly related to the increase of blood pressure both during wakefulness and sleep stages. The changes of deoxygenation and reoxygenation speeds are the important factors for NBPF in the OSA patients.

Key words: deoxygenation speed, reoxygenation speed, obstructive sleep apnea, hypertension

中图分类号:

R332

陈月,于蕾,兰晓馨,贾思琪,袁海波. 氧降和复氧速率对阻塞性睡眠呼吸暂停患者昼夜血压的影响[J]. 吉林大学学报(医学版), 2021, 47(4): 1008-1013.

Yue CHEN,Lei YU,Xiaoxin LAN,Siqi JIA,Haibo Yuan. Effects of deoxygenation and reoxygenation speeds on diurnal and nocturnal blood pressure in obstructive sleep apnea patients[J]. Journal of Jilin University(Medicine Edition), 2021, 47(4): 1008-1013.

图/表 4

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Group	n	Age(year)	Gender (male/female)	BMI(kg·m^－2)	TST(t/min)	N1 (η/%)	N2 (η/%)
OSA－HT	47	41±10	41/6	28.08±3.93	343.97±86.75	32.8(20.9－55.2)	35.20±9.44
OSA+HT	59	39±8	57/2	31.43±4.73	354.38±93.64	58.0(48.6－62.3)	30.66±8.02
t/Z		1.187	1.827	－3.991	－0.592	－4.496	2.627
P		0.238	0.071	<0.01	0.558	<0.01	0.010
Group	n	N3 (η/%)	REM(η/%)	AHI(events/h)	SpO₂ nadir(η/%)	AI (events/h)	NBPF(η/%)
OSA－HT	47	22.13±10.97	12.96±5.26	58.0(25.2－77.7)	79.04±9.52	75.89±24.96	46.50±32.68
OSA+HT	59	9.39±8.04	12.68±10.82	82.0(70.6－96.2)	67.68±9.99	93.65±47.69	81.30±41.41
t/Z		4.817	0.176	－4.445	5.976	－2.467	－4.812
P		<0.01	0.861	<0.01	<0.01	0.015	<0.01

Group	n	Deoxygenation speed	Reoxygenation speed
OSA－HT	47	0.33±0.16	0.71±0.52
OSA+HT	59	0.49±0.18	1.08±0.46
t		－4.633	－3.902
P		<0.01	<0.01

Hypoxia parameter	Blood pressure	r	P
Deoxygenation speed	SBP during wakefulness	0.166	0.089
	DBP during wakefulness	0.203	0.037
	MAP during wakefulness	0.219	0.024
	SBP during sleep	0.311	0.001
	DBP during sleep	0.245	0.011
	MAP during sleep	0.308	0.001
Reoxygenation speed	SBP during wakefulness	0.176	0.071
	DBP during wakefulness	0.250	0.010
	MAP during wakefulness	0.259	0.007
	SBP during sleep	0.327	0.001
	DBP during sleep	0.288	0.003
	MAP during sleep	0.343	0.000

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