Levinson P D, Millman R P
Division of Endocrinology, Brown University, Providence, RI.
Arch Intern Med. 1991 Mar;151(3):455-62.
The obstructive sleep apnea (OSA) syndrome has been considered to be a cause of both transient blood pressure elevations during sleep and sustained hypertension during the awake state. The purpose of this review was to examine critically the existing literature regarding (1) the blood pressure alterations associated with OSA, (2) causal mechanisms relating specific blood pressure alterations to OSA, and (3) potential consequences of the systemic circulatory abnormalities associated with OSA. Particular attention was directed at studies that assessed the prevalence of OSA in patients with hypertension and that examined the effects on blood pressure of treatment of OSA. We conclude that patients with OSA have abnormal sleep blood pressure patterns, manifested most frequently by apnea-associated blood pressure elevations. Confounding factors such as obesity and antihypertensive drug therapy, and conflicting evidence regarding changes in daytime blood pressure after therapy for OSA, make it premature to conclude that OSA and daytime hypertension are directly associated. Circumstantial evidence suggests that the blood pressure alterations that occur during sleep could contribute to the high cardiovascular morbidity in patients with OSA. Further research into the relationship between OSA and hypertension should improve the future care of patients with these conditions and enhance our understanding of cardiopulmonary pathophysiology.
阻塞性睡眠呼吸暂停（OSA）综合征被认为是睡眠期间血压短暂升高以及清醒状态下持续性高血压的一个病因。本综述的目的是严格审视现有文献，内容涉及：（1）与OSA相关的血压变化；（2）将特定血压变化与OSA联系起来的因果机制；（3）与OSA相关的全身循环异常的潜在后果。特别关注评估高血压患者中OSA患病率以及研究OSA治疗对血压影响的研究。我们得出结论，OSA患者存在异常的睡眠血压模式，最常见的表现是与呼吸暂停相关的血压升高。肥胖和抗高血压药物治疗等混杂因素，以及关于OSA治疗后日间血压变化的相互矛盾的证据，使得过早得出OSA与日间高血压直接相关的结论还为时过早。间接证据表明，睡眠期间发生的血压变化可能导致OSA患者心血管疾病高发病率。对OSA与高血压之间关系的进一步研究应能改善这些患者未来的治疗，并增进我们对心肺病理生理学的理解。
