Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
J Clin Sleep Med. 2019 Jul 15;15(7):957-963. doi: 10.5664/jcsm.7870.
Systemic hypertension is highly prevalent in obstructive sleep apnea (OSA) but there are limited data on OSA prevalence in cohorts with hypertension comparing dippers and nondippers. We investigated this relationship in a clinic-based cohort of patients with hypertension who were not screened for any pretest possibility of OSA.
A total of 100 patients with hypertension aged (mean ± SD) 58 ± 10 years, body mass index 30.5 ± 6.1 kg/m2, and Epworth Sleepiness Scale score 6 ± 4 were included. All underwent overnight attended sleep studies and 24-hour ambulatory blood pressure monitoring. The primary study end-point was OSA prevalence based on the standard criteria of apnea-hypopnea index (AHI) ≥ 15 events/h in patients with dipping and nondipping nocturnal blood pressure.
Results showed 10.5% of dippers and 43.5% of nondippers had an AHI ≥ 15 (chi-square = .001). In univariate analysis, AHI correlated significantly with blood pressure dip ( = -.26, < .05), as did ESS ( = -.28, < .05). In linear regression, AHI predicted the magnitude of blood pressure dip (standardised β = -.288, = .03), whereas age, body mass index, systolic blood pressure and diastolic blood pressure did not.
Patients with nondipping nocturnal blood pressure are at high risk of OSA, regardless of symptom profile, which supports the recommendation that such patients should be assessed for co-existing OSA.
阻塞性睡眠呼吸暂停（OSA）患者中普遍存在系统性高血压，但关于比较杓型和非杓型血压患者中 OSA 患病率的数据有限。我们在一个以诊所为基础的高血压患者队列中研究了这种关系，这些患者在进行任何 OSA 术前筛查之前都没有被筛选过。
共纳入 100 名年龄（平均 ± 标准差）为 58 ± 10 岁、体重指数为 30.5 ± 6.1kg/m2、Epworth 睡眠量表评分为 6 ± 4 的高血压患者。所有患者均接受了夜间有监测的睡眠研究和 24 小时动态血压监测。主要研究终点是根据夜间血压杓型和非杓型患者的标准标准（呼吸暂停低通气指数[AHI]≥15 次/小时）确定 OSA 的患病率。
结果显示，10.5%的杓型血压患者和 43.5%的非杓型血压患者的 AHI≥15（卡方检验， =.001）。在单因素分析中，AHI 与血压下降显著相关（ = -.26， <.05），ESS 也与血压下降显著相关（ = -.28， <.05）。在线性回归中，AHI 预测了血压下降的幅度（标准化 β= -.288， =.03），而年龄、体重指数、收缩压和舒张压则不能。
无论症状谱如何，夜间非杓型血压患者都有发生 OSA 的高风险，这支持了建议此类患者应评估是否存在并存的 OSA 的建议。
