Department of Respiratory Diseases, Beijing University People's Hospital, Beijing 100044, China.
Chin Med J (Engl). 2010 Jan 5;123(1):18-22.
Epidemiologic studies have shown an independent and definite association between obstructive sleep apnea (OSA) and hypertension. This study aimed to define the association between daytime blood pressure and severity of OSA in Chinese population in mainland of China.
Twenty university hospital sleep centers in mainland of China were invited by the Chinese Medical Association (CMA) to participate in this epidemiologic study and 2297 consecutive patients (aged 18 - 85 years; 1981 males and 316 females) referred to these twenty sleep centers for evaluation of OSA between January 2004 and April 2006 were prospectively enrolled. Nocturnal polysomnography was performed in each patient, and disease severity was assessed based on the apneahypopnea index (AHI). These patients were classfied into four groups: nonapneic control (control, n = 257) with AHI < or = 5 episodes/hour; mild sleep apnea (mild, n = 402) with AHI > 5 and < or = 15 episodes/hour; moderate sleep apnea (moderate, n = 460) with AHI > 15 and < or = 30 episodes/hour and severe sleep apnea (severe, n = 1178) with AHI > 30 episodes/hour. Daytime blood pressure measurements were performed under standardized conditions in each patient at 10 a.m. in office on the day of referring to sleep centers for getting average value. All the patients were requested to quit medications related to blood pressure for three days before the day of assessing.
Both daytime systolic blood pressure and diastolic blood pressure values were significantly related to AHI positively (r = 0.201 and 0.276, respectively; both P values < 0.001) and to nadir nocturnal oxygen saturation negatively (r = -0.215 and -0.277, respectively; both P values < 0.001), which were the parameters of OSA severity. In two special designed mean plots, means of daytime systolic and diastolic blood pressure increased gradually with increasing AHI. Beyond AHI of 61 - 65, this increasing trend reached a plateau.
The results showed that OSA severity was associated with daytime blood pressure until AHI of 61 - 65, providing evidence for early OSA management, especially in OSA patients with concomitant hypertension.
流行病学研究表明阻塞性睡眠呼吸暂停（OSA）与高血压之间存在独立且明确的关联。本研究旨在确定中国人群中白天血压与 OSA 严重程度之间的关系。
中华医学会（CMA）邀请中国大陆的 20 家大学医院睡眠中心参加这项流行病学研究，2004 年 1 月至 2006 年 4 月期间，连续有 2297 例年龄在 18-85 岁（男性 1981 例，女性 316 例）的患者因 OSA 被转诊至这 20 家睡眠中心进行评估，前瞻性纳入这些患者。对每位患者进行夜间多导睡眠图检查，根据呼吸暂停低通气指数（AHI）评估疾病严重程度。将这些患者分为四组：非呼吸暂停对照组（对照组，n=257），AHI≤5 次/小时；轻度睡眠呼吸暂停（轻度组，n=402），AHI＞5 次/小时且≤15 次/小时；中度睡眠呼吸暂停（中度组，n=460），AHI＞15 次/小时且≤30 次/小时；重度睡眠呼吸暂停（重度组，n=1178），AHI＞30 次/小时。在患者被转诊至睡眠中心的当天上午 10 点，在办公室进行日间血压测量，取平均值。所有患者均被要求在评估前三天停止与血压相关的药物。
日间收缩压和舒张压值与 AHI 呈正相关（r=0.201 和 0.276，均 P 值＜0.001），与夜间最低血氧饱和度呈负相关（r=-0.215 和-0.277，均 P 值＜0.001），这是 OSA 严重程度的参数。在两个特殊设计的平均图中，日间收缩压和舒张压的平均值随着 AHI 的增加逐渐升高。当 AHI 超过 61-65 时，这种升高趋势达到平台期。
结果表明，OSA 严重程度与日间血压有关，直至 AHI 达到 61-65，这为早期 OSA 管理提供了证据，尤其是在伴有高血压的 OSA 患者中。
