Zheng Tao, Zhang Li, Tian Guang-yong, Yu Qiao-lian, Liao Rui-heng, Liang Li-na
Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 May;47(5):383-7.
To investigate the effect of uvulopalatopharyngoplasty (UPPP) to obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with resistant hypertension (RH).
UPPP and modified UPPP were performed on 36 moderate and severe OSAHS patients, who also suffered from RH [who taking more than three kinds of antihypertensive drugs (including diuretics) and still not able to control blood pressure at 140/90 mm Hg (1 mm Hg = 0.133 kPa)]. Polysomnography monitoring, ambulatory blood pressure monitoring, apnea hypopnea index (AHI), lowest saturation of blood oxygen (SaO2) and the changes of antihypertensive medication dosage were performed to the patients before and 6 months after the surgery.
Six months after surgery,the total efficiency was 61.1% (22/36). The AHI median [25 quartile; 75 quartile] from 37.5 [26.0; 48.3]/h to 9.5 [9.0; 21.3]/h, the lowest the SaO2 average (x(-) ± s, the same below) increased from 0.655 ± 0.114 to 0.860 ± 0.037, the differences were statistically significant (P value < 0.05). 24 h systolic blood pressure, daytime systolic blood pressure, night contraction, diastolic and mean arterial pressure decreased from (160.8 ± 6.8), (170.5 ± 2.5), (163.6 ± 10.5), (100.8 ± 5.6) and (96.8 ± 7.5) mm Hg to (142.5 ± 7.3), (150.8 ± 7.6), (140.1 ± 6.4), (81.8 ± 7.4) and (93.7 ± 2.4) mm Hg, the differences were statistically significant (P < 0.05). The degrees of AHI descent and the average SaO2 improvement were concerned with the degree of systolic blood pressure, diastolic blood pressure decent (r > 0.80 and r(2) > 0.50). The average numbers of antihypertensive drugs decreased form (3.6 ± 0.5) to (2.9 ± 0.5) compared preoperatively and postoperatively, the difference was statistically significant (t = 5.537, P < 0.01). The use of antihypertensive medication reduced in 23 cases (23/36, 63.8%) compared preoperatively and postoperatively.
The blood pressure of the patients with OSAHS and RH dropped significantly after UPPP surgery. Recent follow-up shows that the varieties of antihypertensive drugs taken in these patients are reduced significantly after operation.
探讨悬雍垂腭咽成形术（UPPP）对难治性高血压（RH）合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的影响。
对36例中重度OSAHS且合并RH的患者[服用三种以上降压药物（包括利尿剂）且血压仍不能控制在140/90 mmHg（1 mmHg = 0.133 kPa）]行UPPP及改良UPPP手术。对患者手术前及术后6个月进行多导睡眠图监测、动态血压监测、呼吸暂停低通气指数（AHI）、最低血氧饱和度（SaO2）及降压药物剂量变化情况。
术后6个月，总有效率为61.1%（22/36）。AHI中位数[第25四分位数；第75四分位数]由37.5[26.0；48.3]/h降至9.5[9.0；21.3]/h，最低SaO2平均值（x(-)±s，下同）由0.655±0.114升至0.860±0.037，差异有统计学意义（P值<0.05）。24 h收缩压、日间收缩压、夜间收缩压、舒张压及平均动脉压分别由（160.8±6.8）、（170.5±2.5）、（163.6±10.5）、（100.8±5.6）及（96.8±7.5）mmHg降至（142.5±7.3）、（150.8±7.6）、（140.1±6.4）、（81.8±7.4）及（93.7±2.4）mmHg，差异有统计学意义（P<0.05）。AHI下降程度及平均SaO2改善程度与收缩压、舒张压下降程度相关（r>0.80且r(2)>0.50）。术前术后平均降压药物种类由（3.6±0.5）种降至（2.9±0.5）种，差异有统计学意义（t = 5.537，P<0.01）。与术前相比，23例（23/36，63.8%）患者术后降压药物使用减少。
OSAHS合并RH患者UPPP手术后血压明显下降。近期随访显示，这些患者术后服用的降压药物种类明显减少。
