Nieto F J, Young T B, Lind B K, Shahar E, Samet J M, Redline S, D'Agostino R B, Newman A B, Lebowitz M D, Pickering T G
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA.
JAMA. 2000 Apr 12;283(14):1829-36. doi: 10.1001/jama.283.14.1829.
Sleep-disordered breathing (SDB) and sleep apnea have been linked to hypertension in previous studies, but most of these studies used surrogate information to define SDB (eg, snoring) and were based on small clinic populations, or both.
To assess the association between SDB and hypertension in a large cohort of middle-aged and older persons.
Cross-sectional analyses of participants in the Sleep Heart Health Study, a community-based multicenter study conducted between November 1995 and January 1998.
A total of 6132 subjects recruited from ongoing population-based studies (aged > or = 40 years; 52.8% female).
Apnea-hypopnea index (AHI, the average number of apneas plus hypopneas per hour of sleep, with apnea defined as a cessation of airflow and hypopnea defined as a > or = 30% reduction in airflow or thoracoabdominal excursion both of which are accompanied by a > or = 4% drop in oxyhemoglobin saturation) [corrected], obtained by unattended home polysomnography. Other measures include arousal index; percentage of sleep time below 90% oxygen saturation; history of snoring; and presence of hypertension, defined as resting blood pressure of at least 140/90 mm Hg or use of antihypertensive medication.
Mean systolic and diastolic blood pressure and prevalence of hypertension increased significantly with increasing SDB measures, although some of this association was explained by body mass index (BMI). After adjusting for demographics and anthropometric variables (including BMI, neck circumference, and waist-to-hip ratio), as well as for alcohol intake and smoking, the odds ratio for hypertension, comparing the highest category of AHI (> or = 30 per hour) with the lowest category (< 1.5 per hour), was 1.37 (95% confidence interval [CI], 1.03-1.83; P for trend = .005). The corresponding estimate comparing the highest and lowest categories of percentage of sleep time below 90% oxygen saturation (> or = 12% vs < 0.05%) was 1.46 (95% CI, 1.12-1.88; P for trend <.001). In stratified analyses, associations of hypertension with either measure of SDB were seen in both sexes, older and younger ages, all ethnic groups, and among normal-weight and overweight individuals. Weaker and nonsignificant associations were observed for the arousal index or self-reported history of habitual snoring.
Our findings from the largest cross-sectional study to date indicate that SDB is associated with systemic hypertension in middle-aged and older individuals of different sexes and ethnic backgrounds.
既往研究已将睡眠呼吸紊乱（SDB）和睡眠呼吸暂停与高血压联系起来，但这些研究大多使用替代信息来定义SDB（如打鼾），并且基于小诊所人群，或两者皆有。
评估一大群中老年人中SDB与高血压之间的关联。
对睡眠心脏健康研究参与者进行横断面分析，该研究是一项于1995年11月至1998年1月开展的基于社区的多中心研究。
从正在进行的基于人群的研究中招募的总共6132名受试者（年龄≥40岁；女性占52.8%）。
通过无人值守的家庭多导睡眠图获得呼吸暂停低通气指数（AHI，即每小时睡眠中呼吸暂停加低通气的平均次数，呼吸暂停定义为气流停止，低通气定义为气流或胸腹运动减少≥30%，且两者均伴有氧合血红蛋白饱和度下降≥4%）[校正后]。其他指标包括觉醒指数；氧饱和度低于90%的睡眠时间百分比；打鼾史；以及高血压的存在情况，高血压定义为静息血压至少为140/90 mmHg或使用抗高血压药物。
随着SDB指标的增加，平均收缩压和舒张压以及高血压患病率显著升高，尽管这种关联部分可由体重指数（BMI）解释。在调整人口统计学和人体测量学变量（包括BMI、颈围和腰臀比）以及酒精摄入量和吸烟情况后，将AHI最高类别（≥每小时30次）与最低类别（<每小时1.5次）相比，高血压的比值比为1.37（95%置信区间[CI]，1.03 - 1.83；趋势P值 = 0.005）。将氧饱和度低于90%的睡眠时间百分比最高和最低类别（≥12% vs <0.05%）进行比较的相应估计值为1.46（95%CI，1.12 - 1.88；趋势P值<0.001）。在分层分析中，无论男女、年龄大小、所有种族群体以及正常体重和超重个体中，高血压与SDB的任何一项指标均存在关联。对于觉醒指数或自我报告的习惯性打鼾史，观察到的关联较弱且无统计学意义。
我们来自迄今为止最大规模横断面研究的结果表明，SDB与不同性别和种族背景的中老年人的系统性高血压相关。
