Amin Raouf, Somers Virend K, McConnell Keith, Willging Paul, Myer Charles, Sherman Marc, McPhail Gary, Morgenthal Ashley, Fenchel Matthew, Bean Judy, Kimball Thomas, Daniels Stephen
Cincinnati Children's Hospital Medical Center, Ohio, USA.
Hypertension. 2008 Jan;51(1):84-91. doi: 10.1161/HYPERTENSIONAHA.107.099762. Epub 2007 Dec 10.
Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.
小儿睡眠呼吸障碍是否会增加血压升高及血压依赖性心脏重塑的风险，目前仍存在疑问。我们检验了以下假设：与健康对照组相比，睡眠呼吸障碍儿童经活动调整后的早晨血压激增、血压负荷以及日间和夜间血压显著更高，且这些血压参数与左心室重塑有关。对两组之间的24小时动态血压参数进行了比较。测量了血压与左心室相对壁厚度和质量之间的关联。140名儿童符合纳入标准。在呼吸暂停低通气指数每小时<5次的儿童中，与对照组的显著差异在于早晨血压激增。呼吸暂停低通气指数超过每小时5次的儿童，其血压激增、血压负荷以及24小时动态血压均有显著升高。睡眠呼吸障碍和体重指数对血压参数有相似的影响，但夜间舒张压除外，睡眠呼吸障碍对其的影响显著大于体重指数。日间和夜间收缩压、舒张压以及平均动脉血压可预测左心室相对壁厚度的变化。因此，原本健康的儿童出现睡眠呼吸障碍与早晨血压激增、血压负荷以及24小时动态血压升高独立相关。左心室重塑与24小时血压之间的关联突出了睡眠呼吸障碍在增加心血管疾病发病率方面的作用。
