老年人高血压合并阻塞性睡眠呼吸暂停综合征临床剖析.docVIP

老年人高血压合并阻塞性睡眠呼吸暂停综合征临床剖析 　　【中图分类号】R544 【文献标识码】 A【文章编号】1672-3873（2011）03-0104-03 　　【摘要】目的： 初步探讨高血压合并阻塞性睡眠呼吸暂停综合征老年患者的血压变化及可能机制。方法：老年人高血压患者68例，单纯性高血压组14例，高血压合并OSAS54例（高血压伴轻度睡眠呼吸暂停综合征22例、高血压伴中度睡眠呼吸暂停综合征16例、高血压伴重度睡眠呼吸暂停综合征16例），健康对照组16例。各组均行夜间7h的多导睡眠分析仪和24小时动态血压监测，比较各组血压变化、睡眠呼吸参数和血氧饱和度变化、血压昼夜变化及晨峰现象。结果：在降压治疗期间，单纯高血压或者合并OSAS患者24h动态血压控制在正常水平（130/80mmHg）。夜间血压下降率在单纯高血压或者合并OSAS组均低于对照组（P0.05,or P0.01），合并OSAS组中、重度组下降率最低(P0.05)，合并OSAS组反杓型较单纯高血压组多(P0.05)，以重度OSAS组最多(P0.05)，晨峰现象不明显。讨论：OSAS与高血压有很强的相关性，老年血压合并OSAS患者，非杓型高血压发生率高于单纯高血压组。 　　【关键词】高血压 睡眠呼吸暂停综合征 昼夜节律 　　 【Abstract】Objective To investigate the change and the potential mechanism of hypertenion in the elderly hypertensive patients sleep apnea syndrome. Methods 68 elderly patients with hypertension were divided into two groups,including 14 patients with simple hypertension and 54 patients with OSAS,which were further divided into three subgroups according to apnes-hypopnea index(AHI),with 22 patients in mild OSAS subgroup,16 patients in moderate OSAS subgroup and 16 patients in severe OSAS subgroup. 16 people without hypertension and OSAS were chosen as normal control. All the patients were monitored by Polysomnography for seven hours at night and their 24h ambulatory blood pressure were examined The blood pressure level,sleeping structure and respiratory parameters ,the nighttime circadian and the phenomena of moming blood pressure surge were compared among all groups. Results During antihypertension treatment,the fluctuation of 24h ambulatory blood pressure of both the patients with simple hypertension and those combined with OSAS were in nomal level(130/80mmHg).The nocturnal rate in the simple hypertension group or combined with OSAS group was lower than that in the control group (P0.05,or P0.01).Among them ,the noctumal reduction rate in the moderate subgroup and the severe subgroup were the lowst(P0.05).The blood pressure curves of nevers-dippers in the combined with OSAS group were more than those in the group with sim