Lopez-Sublet M, Le Jeune S, Giroux-Leprieur B, Agnoletti D, Dhote R, Mourad J J
Service de médecine interne, université Paris XIII, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
Service de médecine interne, université Paris XIII, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
Ann Cardiol Angeiol (Paris). 2014 Jun;63(3):140-4. doi: 10.1016/j.ancard.2014.05.004. Epub 2014 Jun 2.
Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients.
In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24h urinary catecholamine dosage were included.
Mean age was 51±11 years (30-76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14±9 (2-32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24h urinary normetanephrine (1931±1285 vs 869±293nmol/24h; P<0.05). However, this difference was not significant when this parameter was adjusted to 24h urinary creatinine. We observed a significant positive correlation between AHI and 24h urinary normetanephine (r=0.486; P=0.035).
This pilot study confirms an isolated elevation of 24h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion.
成人阻塞性睡眠呼吸暂停等睡眠障碍与交感神经活动增加有关，交感神经活动增加会导致高血压，并可能与顽固性高血压有关。一些研究表明，阻塞性睡眠呼吸暂停患者尿儿茶酚胺水平升高，持续气道正压通气治疗可能会降低该水平。然而，很少有研究表明高血压患者的呼吸暂停低通气指数与尿儿茶酚胺水平之间存在相关性。
在这项初步研究中，纳入了20名因高血压检查而转诊的患者，这些检查包括夜间多导睡眠图和24小时尿儿茶酚胺测定。
平均年龄为51±11岁（30 - 76岁），68%为男性。检查结束时，13名患者被确诊为阻塞性睡眠呼吸暂停。平均呼吸暂停低通气指数为14±9（2 - 32）。阻塞性睡眠呼吸暂停患者中唯一显著升高的尿儿茶酚胺参数是24小时尿去甲变肾上腺素（1931±1285 vs 869±293nmol/24h；P<0.05）。然而，当将该参数调整为24小时尿肌酐时，这种差异并不显著。我们观察到呼吸暂停低通气指数与24小时尿去甲变肾上腺素之间存在显著正相关（r = 0.486；P = 0.035）。
这项初步研究证实了阻塞性睡眠呼吸暂停的高血压患者24小时尿去甲变肾上腺素单独升高，并表明呼吸暂停低通气指数所表示的睡眠障碍与尿儿茶酚胺排泄之间存在显著相关性。
