氧减率作为严重阻塞性睡眠呼吸暂停中一种新的间歇性低氧血症参数，与高血压密切相关。
Oxygen desaturation rate as a novel intermittent hypoxemia parameter in severe obstructive sleep apnea is strongly associated with hypertension.
机构信息
Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Jiangsu, China; *Contributed equally.
出版信息
J Clin Sleep Med. 2020 Jul 15;16(7):1055-1062. doi: 10.5664/jcsm.8396.
STUDY OBJECTIVES
To investigate the effects of different intermittent hypoxemia properties on blood pressure (BP) and short-term blood pressure variability (BPV) in severe obstructive sleep apnea (OSA) patients.
METHODS
Nocturnal BP was continuously monitored by measuring pulse transmit time. Apnea-related systolic BP elevation values were used to reflect BPV. Beat-to-beat R-R interval data were incorporated in polysomnography for heart rate variability analysis. The low-frequency/high-frequency band ratio was used to reflect sympathovagal balance. The rate of pulse oxyhemoglobin saturation (SpO₂) decrease was counted as the change in the percentage of SpO₂ per second after obstructive apnea and expressed as the oxygen desaturation rate (ODR). Patients with severe OSA (n = 102) were divided into 2 groups according to the median ODR: faster ODR (FODR group: ODR > 0.37, n = 50) and slower ODR (ODR ≤ 0.37, n = 52).
RESULTS
Comparisons between the 2 groups showed significantly higher systolic BP (SBP) values in the FODR group than in the slower ODR group (awake SBP 149.9 ± 18.3 vs 131.8 ± 15.6 mm Hg; asleep SBP: 149.6 ± 19.9 vs 128.7 ± 15.6 mm Hg; both P < .001), as well as short-term BPV (15.0 ± 4.8 vs 11.6 ± 3.6 mm Hg; P < .001), and the prevalence of hypertension (74.0% vs 26.9%; P < .001). Multiple linear regression analyses revealed that after adjusting for body mass index, functional residual capacity, expiratory reserve volume, and baseline SpO ODR, as assessed by ΔSpO₂/Δt, had the strongest association with both BP and short-term BPV. Correlation analysis showed that ODR was positively correlated with the low-frequency/high-frequency band ratio (r = .288, P = .003).
CONCLUSIONS
ODR, as a novel hypoxemia profile, was more closely associated with the elevation of BP and BPV in patients with severe OSA. FODR might be associated with enhanced sympathetic activity.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Characteristics of Obstructive Sleep Apnea Syndrome Related Hypertension and the Effect of Continuous Positive Airway Pressure Treatment on Blood Pressure; URL: https://clinicaltrials.gov/ct2/show/NCT03246022; Identifier: NCT03246022.
研究目的
研究不同间歇性低氧血症特征对重度阻塞性睡眠呼吸暂停（OSA）患者血压（BP）和短期血压变异性（BPV）的影响。
方法
通过测量脉搏传输时间连续监测夜间 BP。呼吸暂停相关的收缩压升高值用于反映 BPV。将逐搏 R-R 间期数据纳入多导睡眠图进行心率变异性分析。低频/高频带比用于反映交感神经-副交感神经平衡。计算脉搏血氧饱和度（SpO₂）下降率作为阻塞性呼吸暂停后 SpO₂每秒钟下降的百分比，并用氧饱和度下降率（ODR）表示。将 102 例重度 OSA 患者（n = 102）按 ODR 的中位数分为 2 组：较快的 ODR（FODR 组：ODR > 0.37，n = 50）和较慢的 ODR（ODR ≤ 0.37，n = 52）。
结果
两组比较显示，FODR 组的收缩压（SBP）值明显高于较慢 ODR 组（觉醒 SBP：149.9 ± 18.3 比 131.8 ± 15.6 mmHg；睡眠 SBP：149.6 ± 19.9 比 128.7 ± 15.6 mmHg；均 P <.001），短期 BPV 也更高（15.0 ± 4.8 比 11.6 ± 3.6 mmHg；P <.001），高血压患病率也更高（74.0%比 26.9%；P <.001）。多线性回归分析显示，在调整体重指数、功能残气量、呼气储备量和基线 SpO₂后，以 ΔSpO₂/Δt 评估的 ODR 与 BP 和短期 BPV 均具有最强的相关性。相关性分析显示，ODR 与低频/高频带比呈正相关（r =.288，P =.003）。
结论
ODR 作为一种新的低氧血症特征，与重度 OSA 患者的 BP 升高和 BPV 更密切相关。较快的 ODR 可能与交感神经活动增强有关。
临床试验注册
注册号：ClinicalTrials.gov；名称：阻塞性睡眠呼吸暂停综合征相关高血压的特征及持续气道正压通气治疗对血压的影响；网址：https://clinicaltrials.gov/ct2/show/NCT03246022；标识符：NCT03246022。
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