Department of Respiratory and Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China.
Medicine (Baltimore). 2024 Nov 29;103(48):e40740. doi: 10.1097/MD.0000000000040740.
Obstructive sleep apnea (OSA) is a respiratory disease closely associated with hypertension and heart disease. This study aimed to evaluate the diagnostic value of rapid eye movement (REM) sleep during nocturnal hypertension in OSA patients. We selected 194 patients who underwent polysomnography (PSG) at the Respiratory and Critical Care Medicine Department of Jiading District Central Hospital in Shanghai between January 2021 and August 2023. All patients were assigned to the hypertension and normal blood pressure groups, and the differences between the 2 groups were compared. This study included 194 patients (137 with nocturnal hypertension and 57 with normal nocturnal blood pressure). The proportion of male sex, body mass index, apnea-hypopnea index (AHI), REM sleep duration, percentage of REM sleep duration to total sleep duration, REM-AHI, nonrapid eye movement-AHI, oxygen desaturation index (ODI), REM-ODI, nonrapid eye movement-ODI, and average nighttime heart rate during sleep were higher in the hypertension group than in the normal blood pressure group, and the lowest oxygen saturation was lower than that in the normal blood pressure group (P < .05). Logistic regression analysis showed that REM-AHI was an independent risk factor for nocturnal hypertension (adjusted odds ratio, 1.048; 95% confidence interval, 1.011-1.086; P = .01). Receiver operating characteristic curve analysis showed that the REM-AHI had an area under the curve of 0.721 (95% confidence interval, 0.641-0.801; P < .001) for diagnosing nocturnal hypertension in patients with OSA, with a maximum Youden index of 0.379. The optimal critical value of the REM-AHI was 23.6 times/h, with a sensitivity of 64.2% and specificity of 73.7%. REM sleep is closely related to nocturnal hypertension, and patients with OSA are more prone to cardiovascular events.
阻塞性睡眠呼吸暂停（OSA）是一种与高血压和心脏病密切相关的呼吸系统疾病。本研究旨在评估快速眼动（REM）睡眠在 OSA 患者夜间高血压中的诊断价值。我们选择了 2021 年 1 月至 2023 年 8 月期间在上海嘉定区中心医院呼吸与危重症医学科进行多导睡眠图（PSG）检查的 194 例患者。所有患者均被分配至高血压组和正常血压组，并比较了两组间的差异。本研究共纳入 194 例患者（夜间高血压 137 例，夜间血压正常 57 例）。高血压组的男性比例、体重指数、呼吸暂停低通气指数（AHI）、REM 睡眠持续时间、REM 睡眠持续时间占总睡眠时间的百分比、REM-AHI、非快速眼动-AHI、氧减指数（ODI）、REM-ODI、非快速眼动-ODI、睡眠时平均夜间心率均高于正常血压组，最低血氧饱和度则低于正常血压组（P 均＜0.05）。Logistic 回归分析显示，REM-AHI 是夜间高血压的独立危险因素（调整优势比，1.048；95%置信区间，1.011-1.086；P ＝0.01）。受试者工作特征曲线分析显示，REM-AHI 对 OSA 患者夜间高血压的诊断曲线下面积为 0.721（95%置信区间，0.641-0.801；P ＜0.001），最大约登指数为 0.379。REM-AHI 的最佳临界值为 23.6 次/h，其灵敏度为 64.2%，特异度为 73.7%。REM 睡眠与夜间高血压密切相关，OSA 患者更易发生心血管事件。
