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Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome

Chinese Medical Journal 2012年第10期125卷 1740-1746页

作者： HE Quan-ying FENG Jing ZHANG Xilong LIANG Zong-an HUANG Shao-guang KANG Jian WANG Guang-fa ZHANG Li-qiang MA Li-jun WANG Bei LIN Qi-chang ZHANG Jin-nong LIU Hui-guo LUO Yuan-ming LIU Jian-hong WANG Shi XIAO Gao-hui LU Gan ZHANG Jin FENG Xue-wei CHEN Bao-yuan Department of Respiratory Diseases Peking University People’s HospitalBelling 100044China Department of Respiratory Diseases Tianjin Medical University General HospitalTianiin 300052China Department of Respiratory Diseases First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China Department of Respiratory Diseases West China HospitalSichuan UniversityChengduSichuan 610041China Department of Respiratory Diseases Ruijin HospitalShanghai Jiao Tbng University School of MedicineShanghai 200025China Department of Respiratory Diseases First Affiliated Hospita1 ofChina Medical UniversityShenyangLiaoning 110001China Department of Respiratory Diseases Peking University First HospitalBeijing 100034China Department of Respiratory Diseases Peking University Third HospitalBeijing 100191China Department of Respiratory Diseases Henan Provincial People’s HospitalZhengzhouHenan 450003China Department of Respiratory Diseases Second Affiliated Hospita1 of Shanxi Medical UniversityTaiyuanShanxi 030001China Department of Respiratory Diseases First Affiliated Hospital of Fujian Medical UniversityFuzhouFuiian 350005China Department of Respiratory Diseases Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologywuhanHubei 430022China Department of Respiratory Diseases Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430030 China Guangzhou Institute of Respiratory Disease.First Affiliated Hospital of Guangzhou Medical College GuangzhouGuangdong 510120China Department of Respiratory Diseases Guangxi Zhuang Autonomous Region People’s HospitalNanningGuangxi 530021China Department of Respiratory Diseases Central Hospita1 of Shenyang Medical College ShenyangLiaoning 110024China Department of Respiratory Diseases Beijing Gongan HospitalBeijing 100006China Department of Respiratory Diseases Jiangsu Senility HospitalNanjingJiangsu 210024China Department of Respiratory Diseases Afiliated Hospita1 of Ningxi

Background The nocturnal nondipping and elevated morning blood pressure （BP） in patients with obstructive sleep apnea syndrome （OSAS） have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. Methods Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points （daytime, evening, nighttime and morning） and polysomnography （PSG） was performed and subjects were classified into four groups by their apnea-hypopnea index （AHI）： control, n=213 with AHI 〈5; mild, n=420 with AHI -〉5 and 〈15; moderate, n=460 with AHI -〉15 and 〈30; and severe, n=1204 with AHI -〉30. SPSS 11.5 software package was used for statistical analysis and figure drawing. Results All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a ＂reversed BP dipping＂ pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. Conclusions OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.

关键词： obstructive sleep apnea syndrome blood pressure hypertension, dipping, polysomnography apnea-hypopnea index

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