Department of Therapeutics and Hypertension, TSA 50032, Rangueil UniversityHospital, 31059 cedex 9, Toulouse, France.
Cardiology Unit, Clinique de l'Union, Saint Jean, 31242, Toulouse, France.
BMC Pulm Med. 2018 Nov 21;18(1):173. doi: 10.1186/s12890-018-0737-y.
Untreated Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is a known factor contributing to resistant hypertension (HT). Continuous Positive Airways Pressure (CPAP) is effective to decrease blood pressure (BP) in severe OSAHS. In our clinical practice, hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS). We aimed to confirm that severe OSAHS is less symptomatic in HT patients than normotensive patients using ESS.
We retrospectively compared two age, gender-matched groups - 100 hypertensive patients and 100 normotensive patients - with severe OSAHS defined as an AHI (Apnea Hypopnea Index) ≥30. OSAHS was considered symptomatic when ESS > 10.
The two groups of patients did not differ significantly with respect to main characteristics including Body Mass Index (BMI), AHI and ODI (Oxygen Desaturation Index). Systolic and Diastolic BP were higher in HT patients (p < 0.01). HT patients were less symptomatic with regard to severe OSAHS with a lower ESS (10.0 vs 11.9, p < 0.01), and a lower number of patients with an ESS > 10 (30% vs 58%, p < 0.01). In multivariable analysis adjusted on age, gender, Obesity, Systolic BP, Diastolic BP, AHI and ADO, normotension was significantly associated with symptomatic OSAHS (OR = 2.83, [1.298-6.192], p < 0.01).
In our study on patients with severe OSAHS, ESS score was lower in hypertensive patients than in normotensive patients. This discrepancy may lead to an underestimation of severe OSAHS in hypertensive patients.
未经治疗的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是导致难治性高血压（HT）的已知因素。持续气道正压通气（CPAP）可有效降低重度 OSAHS 患者的血压（BP）。在我们的临床实践中，与血压正常的患者相比，高血压患者的 OSAHS 症状似乎不那么明显，这导致当使用 Epworth 睡眠量表（ESS）筛查 OSAHS 时，存在漏诊的风险。我们旨在使用 ESS 确认 HT 患者的重度 OSAHS 症状较血压正常的患者轻。
我们回顾性比较了两组年龄、性别匹配的患者 - 100 例高血压患者和 100 例血压正常的患者 - 定义为 AHI（呼吸暂停低通气指数）≥30 的重度 OSAHS。当 ESS>10 时，认为 OSAHS 有症状。
两组患者在主要特征方面无显著差异，包括体重指数（BMI）、AHI 和 ODI（氧减指数）。HT 患者的收缩压和舒张压更高（p<0.01）。HT 患者的重度 OSAHS 症状较轻，ESS 较低（10.0 与 11.9，p<0.01），ESS>10 的患者比例较低（30%与 58%，p<0.01）。在调整年龄、性别、肥胖、收缩压、舒张压、AHI 和 ADO 后进行多变量分析，血压正常与有症状的 OSAHS 显著相关（OR=2.83，[1.298-6.192]，p<0.01）。
在我们对重度 OSAHS 患者的研究中，高血压患者的 ESS 评分低于血压正常的患者。这种差异可能导致高血压患者对重度 OSAHS 的低估。
