伴有心血管病风险的患者阻塞性睡眠呼吸暂停与日间非杓型血压的血液动力学指数。
Obstructive sleep apnea and diurnal nondipping hemodynamic indices in patients at increased cardiovascular risk.
机构信息
aDepartment of Medicine, Case School of Medicine, Cleveland, Ohio bBrigham and Women's Hospital cBeth Israel Deaconess Medical Center dVA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts eJohns Hopkins University, Baltimore, Maryland fDepartment of Epidemiology and Biostatistics, Case Western Reserve University gCleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
出版信息
J Hypertens. 2014 Feb;32(2):267-75. doi: 10.1097/HJH.0000000000000011.
RATIONALE
We hypothesized increasing obstructive sleep apnea (OSA) severity would be associated with nondipping blood pressure (BP) in increased cardiovascular disease (CVD) risk.
METHODS
Baseline data from 298 cardiology patients recruited for a multicenter randomized controlled trial were examined. Dipping was defined as a sleep-related BP or heart rate (HR) reduction of at least 10%. Logistic regression models were fit, adjusting for age, sex, race, BMI, CVD risk factors, CVD, and study site.
RESULTS
There was a statistically significant 4% increase in the odds of nondipping SBP per 1-unit increase in both apnea hypopnea index (AHI) and oxygen desaturation index (ODI). There was no significant relationship between AHI and nondipping mean arterial pressure (MAP); however, a 3% increase in the odds of nondipping MAP per 1-unit increase in ODI was observed [odds ratio (OR) = 1.03; 95% confidence interval (CI) 1.00-1.05]. At severe OSA levels, a 10 and 4% increase in odds of nondipping DBP per 1-unit increase in AHI and ODI were observed, respectively. A 6% [OR = 1.06; 95% CI (1.01-1.10)] increase in nondipping HR odds was observed with each increase in ODI until the upper quartile of ODI.
CONCLUSION
In patients at cardiovascular risk and moderate-to-severe OSA, increasing AHI and/or ODI were associated with increased odds of nondipping SBP and nondipping MAP. More severe levels of AHI and ODI also were associated with nondipping DBP. These results support progressive BP burden associated with increased OSA severity even in patients managed by cardiology specialty care.
原理
我们假设阻塞性睡眠呼吸暂停（OSA）严重程度增加与心血管疾病（CVD）风险增加的非杓型血压（BP）有关。
方法
对 298 名参加多中心随机对照试验的心脏病患者的基线数据进行了检查。定义杓型为睡眠相关血压或心率（HR）降低至少 10%。使用逻辑回归模型进行拟合，调整年龄、性别、种族、BMI、CVD 危险因素、CVD 和研究地点。
结果
每增加 1 个单位的呼吸暂停低通气指数（AHI）和氧减指数（ODI），非杓型收缩压（SBP）的几率增加 4%，这具有统计学意义。AHI 与非杓型平均动脉压（MAP）之间没有显著关系；然而，ODI 每增加 1 个单位，非杓型 MAP 的几率增加 3%[比值比（OR）=1.03；95%置信区间（CI）1.00-1.05]。在严重 OSA 水平下，AHI 和 ODI 每增加 1 个单位，非杓型舒张压（DBP）的几率分别增加 10%和 4%。ODI 每增加 1 个单位，非杓型 HR 几率增加 6%[OR=1.06；95%CI（1.01-1.10)]，直到 ODI 的上四分位数。
结论
在心血管风险和中重度 OSA 的患者中，AHI 和/或 ODI 的增加与非杓型 SBP 和非杓型 MAP 几率的增加相关。更严重的 AHI 和 ODI 水平也与非杓型 DBP 相关。这些结果支持与 OSA 严重程度增加相关的渐进性 BP 负担，即使在接受心脏病学专业治疗的患者中也是如此。
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