Baguet Jean-Philippe, Hammer Laure, Lévy Patrick, Pierre Hélène, Rossini Eliane, Mouret Sandrine, Ormezzano Olivier, Mallion Jean-Michel, Pépin Jean-Louis
Cardiology and Hypertension, University Hospital, Grenoble, France.
J Hypertens. 2005 Mar;23(3):521-7. doi: 10.1097/01.hjh.0000160207.58781.4e.
In newly diagnosed apnoeic patients without a history of hypertension, clinical hypertension is underdiagnosed in at least 40% of the cases. An increase in diastolic blood pressure is the most frequent pattern encountered.
To assess clinic and 24-h blood pressure, baroreflex sensitivity and left ventricular mass for identifying the prevalence, the type and the consequences of hypertension in newly diagnosed apnoeic patients.
Fifty-nine unselected patients (age = 48 +/- 12 years, body mass index = 28.1 +/- 4.5 kg/m2) referred to a university hospital sleep laboratory for symptoms suggesting obstructive sleep apnoea were included. Diagnosis of apnoea was accepted when respiratory disturbance index was > or = 15/h of sleep. Blood pressure was considered as normal by their general practitioner and all of them were free of any medication for hypertension. Echocardiography, 24-hour ambulatory blood pressure monitoring and assessment of the baroreflex sensitivity were performed.
Forty-two percent of the apnoeic patients demonstrated a clinical hypertension, 34 subjects (58%) had a daytime hypertension, and 45 patients (76%) had a night-time hypertension, using 24-h monitoring. All the daytime hypertensives also had night-time hypertension. Forty-seven of the 59 patients (80%) were hypertensive either in the clinic or using 24-h recording. Diastolic and systolo-diastolic hypertension were the prominent types of hypertension observed both by clinic or ambulatory measurements. Respiratory disturbance index was significantly higher in apnoeic patients suffering isolated diastolic hypertension than in the normotensives (50.9 +/- 26.5/h versus 36.0 +/- 12.3/h, respectively; P = 0.02). The prevalence rate of left ventricular hypertrophy was high (between 15 and 20%) and occurred independently of associated hypertension. Baroreflex sensitivity was altered whatever the type of hypertension and decreased with the severity of obstructive sleep apnoea.
Hypertension is hugely underdiagnosed in apnoeic patients unknown to be hypertensive. Use of 24-h blood pressure monitoring allowed the diagnosis of twice as much hypertension than did clinical measurement. Even at the beginning of their history of hypertension, apnoeic patients exhibited chronic adaptations of their cardiovascular system, as shown by early changes in baroreflex sensitivity and an increased prevalence of left ventricular hypertrophy.
在新诊断的无高血压病史的呼吸暂停患者中，临床高血压的漏诊率至少为40%。舒张压升高是最常见的模式。
评估临床和24小时血压、压力反射敏感性和左心室质量，以确定新诊断的呼吸暂停患者中高血压的患病率、类型和后果。
纳入59例因疑似阻塞性睡眠呼吸暂停症状而转诊至大学医院睡眠实验室的未经过筛选的患者（年龄=48±12岁，体重指数=28.1±4.5kg/m²）。当呼吸紊乱指数≥15次/小时睡眠时，呼吸暂停诊断成立。他们的全科医生认为其血压正常，且所有人均未服用任何高血压药物。进行了超声心动图、24小时动态血压监测和压力反射敏感性评估。
使用24小时监测，42%的呼吸暂停患者表现为临床高血压，34名受试者（58%）有日间高血压，45名患者（76%）有夜间高血压。所有日间高血压患者也有夜间高血压。59例患者中有47例（80%）在诊所或使用24小时记录时为高血压。舒张期高血压和收缩期-舒张期高血压是通过临床或动态测量观察到的主要高血压类型。单纯舒张期高血压的呼吸暂停患者的呼吸紊乱指数显著高于血压正常者（分别为50.9±26.5次/小时和36.0±12.3次/小时；P=0.02）。左心室肥厚的患病率较高（15%至20%），且与相关高血压无关。无论高血压类型如何，压力反射敏感性均发生改变，并随阻塞性睡眠呼吸暂停的严重程度而降低。
在未知患有高血压的呼吸暂停患者中，高血压的漏诊情况严重。使用24小时血压监测诊断出的高血压患者数量是临床测量的两倍。即使在高血压病程初期，呼吸暂停患者也表现出心血管系统的慢性适应性改变，如压力反射敏感性的早期变化和左心室肥厚患病率的增加。
