Wang H W, Liu H M, Zheng Z Y, Jia Y Z, Li H R
Department of Otorhinolaryngology Head and Neck Surgery, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
Department of Ultrasound Diagnosis, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Jan 7;52(1):49-52. doi: 10.3760/cma.j.issn.1673-0860.2017.01.009.
To investigate the effect of the treatments for obstructive sleep apnea hypopnea syndrome (OSAHS) on the resistant hypertension (RH) of patients. Eighty patients with OSAHS and RH (blood pressure could not be controlled under 140/90 mmHg (1 mmHg=0.133 kPa) even with more than three kinds of antihypertensive drugs including diuretics) received surgery or continuous positive airway pressure (CPAP) treatment. The results of polysomnography monitoring, ambulatory blood pressure monitoring, and the dosage of antihypertensive medication were recorded before and six months after the treatment. Apnea hypopnea index (AHI) decreased from (32.9±10.8) before treatment to (9.4±6.5) after treatment, while the lowest oxygen saturation (SaO(2)) increased from (0.682±0.062) to (0.884±0.056), with significant differences ( value was 18.863 and 26.614, respectively; both <0.001). Twenty-four hours systolic blood pressure (SBP)/diastolic blood pressure (DBP) decreased respectively from ((150.5±9.8)/(97.8±7.3)) mmHg to ((140.7±6.8)/(88.6±6.3)) mmHg, daytime SBP/DBP decreased from ((154.3±8.9)/(100.6±7.4)) mmHg to ((144.8±5.8)/(91.3±5.5)) mmHg, and nighttime SBP/DBP decreased from ((145.5±8.8)/(93.8±6.4)) mmHg to ((135.8±5.7)/(84.6±5.9)) mmHg, with significant differences ( value was 7.832, 6.903, 7.005, 6.848, 8.025, 7.554, respectively; all <0.001). The reduction of nighttime SBP /DBP was ((11.5±2.2)/(10.2±3.1)) mmHg, and the reduction of daytime SBP/DBP was ((9.0±2.8)/(7.9±3.5)) mmHg. The reduction of nighttime SBP/DBP was more obvious than daytime SBP/DBP, with significant differences ( value was 9.732 and 6.936, respectively; both <0.001). Before treatment, nighttime blood pressure decrease rate below 10% was showed in 75 percent of patients, and after treatment, this rate only in 37.5 percent of patients (χ(2)=22.857, <0.01). The numbers of required antihypertensive drugs decreased in 45 (56.3%) cases, the average numbers of antihypertensive drugs decreased from (3.2±0.4) before treatment to (2.6±0.5) after treatment, with a significant difference (=9.276, <0.01). After treatment of OSAHS, the blood pressure of the patients with OSAHS and RH dropped significantly, the circadian rhythm of blood pressure condition was better, the varieties of antihypertensive drugs taken in these patients were reduced significantly.
探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的治疗方法对患者顽固性高血压（RH）的影响。80例OSAHS合并RH患者（即使使用包括利尿剂在内的三种以上降压药物，血压仍无法控制在140/90 mmHg（1 mmHg = 0.133 kPa）以下）接受手术或持续气道正压通气（CPAP）治疗。记录治疗前及治疗6个月后多导睡眠图监测结果、动态血压监测结果及降压药物用量。呼吸暂停低通气指数（AHI）从治疗前的（32.9±10.8）降至治疗后的（9.4±6.5），而最低血氧饱和度（SaO₂）从（0.682±0.062）升至（0.884±0.056），差异有统计学意义（值分别为18.863和26.614；均<0.001）。24小时收缩压（SBP）/舒张压（DBP）分别从（（150.5±9.8）/（97.8±7.3））mmHg降至（（140.7±6.8）/（88.6±6.3））mmHg，日间SBP/DBP从（（154.3±8.9）/（100.6±7.4））mmHg降至（（144.8±5.8）/（91.3±5.5））mmHg，夜间SBP/DBP从（（145.5±8.8）/（93.8±6.4））mmHg降至（（135.8±5.7）/（84.6±5.9））mmHg，差异有统计学意义（值分别为7.832、6.903、7.005、6.848、8.025、7.554；均<0.001）。夜间SBP/DBP下降幅度为（（11.5±2.2）/（10.2±3.1））mmHg，日间SBP/DBP下降幅度为（（9.0±2.8）/（7.9±3.5））mmHg。夜间SBP/DBP下降幅度比日间SBP/DBP更明显，差异有统计学意义（值分别为9.732和6.936；均<0.001）。治疗前，75%的患者夜间血压下降率低于10%，治疗后，该比例仅为37.5%（χ² = 22.857，<0.01）。45例（56.3%）患者所需降压药物数量减少，降压药物平均数量从治疗前的（3.2±0.4）降至治疗后的（2.6±0.5），差异有统计学意义（=9.276，<0.01）。OSAHS治疗后，OSAHS合并RH患者的血压显著下降，血压昼夜节律情况改善，这些患者服用的降压药物种类显著减少。
