Departments of Respiratory Medicine Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Japan.
J Sleep Res. 2011 Dec;20(4):538-43. doi: 10.1111/j.1365-2869.2011.00912.x. Epub 2011 Feb 9.
Obstructive sleep apnoea (OSA) plays a significant role in increasing blood pressure. Significant decreases were reported in blood pressure of hypertensive OSA patients with sleepiness who underwent continuous positive airway pressure (CPAP) treatment, but not in non-sleepy hypertensive OSA patients. More recently, however, significant decreases in blood pressure in non-sleepy hypertensive OSA patients following CPAP were shown. Effects of sleepiness on hypertension in OSA patients have been investigated, but not the effects of hypertension on sleepiness in OSA patients. We investigated the relationships between hypertension and sleepiness in patients with OSA. We analysed data on 275 middle-aged male subjects from a cross-sectional epidemiological health survey. We measured blood pressure and sleep duration objectively using an actigraph for 7 days and the respiratory disturbance index (RDI) with a type 3 portable device for 2 nights, and assessed sleepiness using the Epworth Sleepiness Scale (ESS). The RDI correlated significantly with ESS scores in the 88 hypertensive subjects (r = 0.33, P = 0.0024), but not in the 187 non-hypertensive subjects (r = -0.01, P = 0.91). Short sleep duration correlated significantly with ESS scores in both groups. Both the RDI and short sleep duration were related independently to sleepiness in only hypertensive subjects. Furthermore, the RDI was related negatively significantly to sleep duration in hypertensive subjects. Although short sleep duration was related significantly to sleepiness in both groups, hypertension may be important for the sleepiness in OSA patients. Detailed mechanisms of the difference in the relationship between sleepiness and the severity of OSA with or without hypertension should be studied further.
阻塞性睡眠呼吸暂停（OSA）在升高血压方面起着重要作用。有研究报道，对于伴有嗜睡的 OSA 高血压患者，持续气道正压通气（CPAP）治疗可显著降低血压，但对于非嗜睡性 OSA 高血压患者则不然。然而，最近有研究表明，CPAP 治疗可显著降低非嗜睡性 OSA 高血压患者的血压。目前已经研究了嗜睡对 OSA 患者高血压的影响，但 OSA 患者的高血压对嗜睡的影响尚未得到研究。我们研究了 OSA 患者中高血压与嗜睡之间的关系。我们分析了一项横断面流行病学健康调查中 275 名中年男性受试者的数据。使用活动记录仪客观测量血压和睡眠持续时间 7 天，使用 3 型便携式设备测量呼吸干扰指数（RDI）2 晚，并使用 Epworth 嗜睡量表（ESS）评估嗜睡程度。在 88 例高血压受试者中，RDI 与 ESS 评分显著相关（r = 0.33，P = 0.0024），但在 187 例非高血压受试者中无相关性（r = -0.01，P = 0.91）。两组中，睡眠持续时间短与 ESS 评分显著相关。仅在高血压组中，RDI 和短睡眠持续时间与嗜睡独立相关。此外，在高血压患者中，RDI 与睡眠持续时间呈负相关。虽然两组中短睡眠持续时间与嗜睡显著相关，但高血压可能是 OSA 患者嗜睡的重要原因。应进一步研究有或无高血压的 OSA 严重程度与嗜睡之间关系差异的详细机制。
