Correa Claudia M, Gismondi Ronaldo A, Cunha Ana Rosa, Neves Mario F, Oigman Wille
Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Universidade Federal Fluminense, Niterói, RJ, Brazil.
Arq Bras Cardiol. 2017 Oct;109(4):313-320. doi: 10.5935/abc.20170130. Epub 2017 Sep 4.
Obesity, systemic arterial hypertension (SAH) and obstructive sleep apnea (OSA) are closely related. Up to 70% of patients with OSA may be asymptomatic, and there is evidence that these patients have cardiovascular disease, especially nocturnal SAH.
The aim of this study was to evaluate 24-hour blood pressure circadian variation in asymptomatic, obese individuals with moderate-to-severe OSA and compare it with that in individuals with mild OSA or without OSA.
Eighty-six obese subjects aged between 30 and 55 years (BMI 30-39 kg/m2), with casual blood pressure < 140/90 mmHg and without comorbidities were recruited. Eighty-one patients underwent clinical and anthropometric assessment, ambulatory blood pressure monitoring (ABPM), and Watch-PAT. Participants were divided into two groups, based on the apnea-hypopnea index (AHI): group 1, with AHI < 15 events/hour, and group 2 with AHI ≥ 15 events/hour.
Compared with group 1, group 2 had higher neck circumference and waist-hip circumference (40.5 ± 3.2 cm vs. 38.0 ± 3.7 cm, p = 0.002, and 0.94 ± 0.05 vs. 0.89 ± 0.05, p = 0.001, respectively), higher systolic and diastolic blood pressure measured by the 24-h ABPM (122 ± 6 vs 118 ± 8 mmHg, p = 0.014, and 78 ± 6 vs 73 ± 7 mmHg, p = 0.008, respectively), and higher nocturnal diastolic pressure load (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Moreover, there was a positive correlation between nocturnal diastolic blood pressure and AHI (r = 0.43, p < 0.05).
Asymptomatic obese subjects with moderate-to-severe OSA have higher systolic and diastolic blood pressure at 24 hours compared with those with absent / mild OSA, despite normal casual blood pressure between the groups. These results indicate that ABPM may be useful in the evaluation of asymptomatic obese patients with moderate-to-severe OSA.
肥胖、系统性动脉高血压（SAH）和阻塞性睡眠呼吸暂停（OSA）密切相关。高达70%的OSA患者可能无症状，且有证据表明这些患者患有心血管疾病，尤其是夜间SAH。
本研究旨在评估无症状的中重度OSA肥胖个体的24小时血压昼夜变化，并将其与轻度OSA个体或无OSA个体进行比较。
招募了86名年龄在30至55岁之间（BMI 30 - 39 kg/m²）、偶测血压<140/90 mmHg且无合并症的肥胖受试者。81名患者接受了临床和人体测量评估、动态血压监测（ABPM）以及Watch-PAT。根据呼吸暂停低通气指数（AHI）将参与者分为两组：第1组，AHI<15次/小时；第2组，AHI≥15次/小时。
与第1组相比，第2组的颈围和腰臀围更大（分别为40.5±3.2 cm对38.0±3.7 cm，p = 0.002；0.94±0.05对0.89±0.05，p = 0.001），24小时ABPM测量的收缩压和舒张压更高（分别为122±6对118±8 mmHg，p = 0.014；78±6对73±7 mmHg，p = 0.008），夜间舒张压负荷更高（44.6±25.9%对31.3±27.3%，p = 0.041）。此外，夜间舒张压与AHI之间存在正相关（r = 0.43，p < 0.05）。
无症状的中重度OSA肥胖个体与无/轻度OSA个体相比，24小时收缩压和舒张压更高，尽管两组之间偶测血压正常。这些结果表明，ABPM可能有助于评估无症状的中重度OSA肥胖患者。
