Osuna Edgar D, Zamora Adrián C, Buitrago Andrés F, Salazar Jaime F, Rosales Santiago A, Galeano Camila, Guzman-Prado Yuli, Ferreira-Atuesta Carolina
Department of Neurology, Fundación Santafé de Bogotá, Bogotá, Colombia.
School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
Sleep Sci. 2023 Jul 6;16(2):197-205. doi: 10.1055/s-0043-1770797. eCollection 2023 Jun.
Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
阻塞性睡眠呼吸暂停（OSA）被认为是动脉高血压（HT）的一个风险因素。一种将这些病症联系起来的推测机制是夜间血压的非勺型（ND）模式，然而证据并不一致，且基于患有基础疾病的特定人群。目前尚无居住在高海拔地区人群中OSA和ND的数据。
确定居住在高海拔地区（波哥大：海拔2640米）的高血压和非高血压但健康的中年个体中，中重度OSA与HT及ND模式的患病率和相关性。
2015年至2017年期间，对诊断为中重度OSA的成年个体进行了24小时动态血压监测（ABPM）。进行单变量和多变量逻辑回归分析以确定HT和ND模式的预测因素。
最终分析纳入了93名个体（男性占62.4%，中位年龄55岁）。总体而言，30.1%的个体在ABPM中呈现ND模式，14.9%的个体有日间和夜间高血压。在多变量回归中，重度OSA（较高的呼吸暂停低通气指数[AHI]）与HT相关（p = 0.006），但与ND模式无关（p = 0.54）。吸烟状况和呼吸事件期间的最低血氧饱和度与ND模式独立相关（p = 0.04），而年龄（p = 0.001）与HT相关。
在我们的样本中，三分之一的中重度OSA个体有非勺型模式，这表明OSA与ND之间缺乏直接关联。AHI较高的老年个体更易患HT，而吸烟者出现ND模式的风险更高。这些发现为OSA与ND模式之间关系所涉及的多种机制增添了更多信息，并对24小时ABPM的常规使用提出了质疑，特别是在我们这个资源和医疗服务有限的地区。然而，需要采用更有力的方法进行进一步研究才能得出结论。
