Tryfon Stavros, Stanopoulos Ioannis, Dascalopoulou Efi, Argyropoulou Paraskevi, Bouros Demosthenes, Mavrofridis Euklides
Respiratory Failure Unit, Aristotle University, General Hospital G. Papanikolaou, Thessaloniki, Greece.
Respiration. 2004 Sep-Oct;71(5):499-504. doi: 10.1159/000080635.
Several studies assessing the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for hypertension have produced conflicting results. Although the sleep apnea syndrome is associated with hypertension, there are no references regarding the blood pressure response of normotensive OSAS patients during exercise.
The aim of this study was to investigate the relationship between diastolic blood pressure (DBP) response during exercise and the severity of OSAS.
We performed exercise testing a day after polysomnography in 17 normotensive males who were admitted for the first time because of OSAS and in 10 normal subjects who were members of the same families. During maximal incremental exercise test (bicycle ergometry) oxygen consumption (VO(2)) and the DBP were estimated at rest and at peak exercise. VO(2) was also measured when DBP were 100 and 110 mm Hg.
At peak exercise DBP was significantly higher in OSAS patients (115.3 +/- 9.2 mm Hg) than in normal subjects (101 +/- 8.4 mm Hg, p < 0.01). OSAS patients reached a DBP of 110 mm Hg with a significantly lower VO(2) than normal subjects (1,881.5 +/- 703.4 vs. 1,972.3 +/- 108.6 ml/min, p = 0.045). VO(2) was not different between the two groups at a DBP of 100 mm Hg (1,211.2 +/- 371.7 vs. 1,536.6 +/- 267.2 ml/min, p = 0.089) but OSAS patients had a significantly lower heart rate than normals (111.2 +/- 13 vs. 118.6 +/- 27.6, p = 0.009). None of the aspects of quality of life, according to the Nottingham Health Profile Questionnaire, Part 1, were significantly different between patients and normal subjects.
Normotensive OSAS patients develop DBP elevation at an earlier stage during exercise compared to normal subjects. This hypertensive response was not correlated with the severity (apnea-hypopnea index, oxygen desaturation parameters) of OSAS. DBP elevation could be a limiting factor of physical performance in this group of patients.
多项评估阻塞性睡眠呼吸暂停综合征（OSAS）作为高血压独立危险因素作用的研究结果相互矛盾。尽管睡眠呼吸暂停综合征与高血压相关，但关于血压正常的OSAS患者运动期间血压反应的参考文献却未见报道。
本研究旨在调查运动期间舒张压（DBP）反应与OSAS严重程度之间的关系。
我们对17例因OSAS首次入院的血压正常男性和10例来自同一家族的正常受试者在多导睡眠图检查后一天进行运动测试。在最大递增运动试验（自行车测力计）期间，于静息和运动峰值时评估耗氧量（VO₂）和DBP。当DBP为100和110 mmHg时也测量VO₂。
运动峰值时，OSAS患者的DBP（115.3±9.2 mmHg）显著高于正常受试者（101±8.4 mmHg，p<0.01）。OSAS患者达到110 mmHg的DBP时，其VO₂显著低于正常受试者（1881.5±703.4对1972.3±108.6 ml/min，p = 0.045）。两组在DBP为100 mmHg时VO₂无差异（1211.2±371.7对1536.6±267.2 ml/min，p = 0.089），但OSAS患者的心率显著低于正常人（111.2±13对118.6±27.6，p = 0.009）。根据诺丁汉健康状况问卷第1部分，患者与正常受试者在生活质量的各个方面均无显著差异。
与正常受试者相比，血压正常的OSAS患者在运动期间更早出现DBP升高。这种高血压反应与OSAS的严重程度（呼吸暂停低通气指数、氧饱和度参数）无关。DBP升高可能是该组患者身体机能的限制因素。
