Stoohs R A, Gingold J, Cohrs S, Harter R, Finlayson E, Guilleminault C
Stanford University Medical School, Sleep Disorders Clinic and Research Center, Palo Alto, California 94304, USA.
J Am Geriatr Soc. 1996 Nov;44(11):1295-300. doi: 10.1111/j.1532-5415.1996.tb01398.x.
To investigate the relationship between sleep-disordered breathing (SDB) and essential hypertension in a population of older male hypertensives.
One-hundred forty consecutive older hypertensive males.
Monitoring of sleep-related breathing abnormality with a portable sleep apnea monitor (level III device). Assessment of complaints related to sleep quality using a validated questionnaire. Systemic arterial blood pressure according to WHO standards and biochemical analyses. SDB was defined as more than 10 abnormal respiratory events per hour of sleep.
Prospective investigation on a retrospective cohort.
Veterans Administrations hypertension clinic.
SDB was diagnosed in 80% of this older, hypertensive, male population. Thirty-four percent of all study subjects presented with severe SDB, with more than 30 abnormal respiratory events per hour of sleep. Subjects with SDB were significantly heavier (BMI = 30.0 +/- 5.2 kg/m2) than subjects without SDB (BMI = 26.8 +/- 5.1 kg/m2, P = .004). Furthermore, subjects with SDB slept significantly longer (by a mean of 46 minutes/night, P = .027) and complained significantly more often of daytime sleepiness than subjects without SDB (P = .018). Fifty percent of all 140 subjects snored more than 10% of the total sleep time, and 26% snored for more than one-third of the night. No significant differences in blood pressure values were observed in subjects with compared with subjects without sleep-disordered breathing. However, a considerable number of subjects presenting with hypertensive blood pressure values despite treatment could be identified. Subjects presenting with hypertensive blood pressure values had a significantly higher severity index of SDB than subjects with normotensive blood pressure values (P = .047).
This investigation supports data showing that undiagnosed SDB is a common phenomenon in older male individuals, leading to impaired daytime functioning and impairment of overall quality of life. More importantly, our data suggests that untreated SDB may have an adverse effect on the efficacy of antihypertensive treatment in hypertensive individuals with sleep-disordered breathing.
在老年男性高血压患者群体中研究睡眠呼吸紊乱（SDB）与原发性高血压之间的关系。
140例连续入选的老年男性高血压患者。
使用便携式睡眠呼吸暂停监测仪（III级设备）监测与睡眠相关的呼吸异常情况。使用经过验证的问卷评估与睡眠质量相关的主诉。按照世界卫生组织标准测量系统性动脉血压并进行生化分析。SDB定义为每小时睡眠中呼吸异常事件超过10次。
对回顾性队列进行前瞻性调查。
退伍军人管理局高血压诊所。
在这个老年男性高血压群体中，80%被诊断为SDB。所有研究对象中34%存在严重SDB，即每小时睡眠中呼吸异常事件超过30次。有SDB的受试者体重明显更重（体重指数[BMI]=30.0±5.2kg/m²），高于无SDB的受试者（BMI=26.8±5.1kg/m²，P=0.004）。此外，有SDB的受试者睡眠时间明显更长（平均每晚长46分钟，P=0.027），且与无SDB的受试者相比，白天嗜睡的主诉明显更多（P=0.018）。140名受试者中有50%打鼾时间超过总睡眠时间的10%，26%打鼾时间超过夜间的三分之一。有睡眠呼吸紊乱的受试者与无睡眠呼吸紊乱的受试者相比，血压值未观察到显著差异。然而，可以识别出相当数量的尽管接受治疗但血压仍处于高血压水平的受试者。血压处于高血压水平的受试者SDB严重程度指数显著高于血压正常的受试者（P=0.047）。
本研究支持以下数据，即未被诊断出的SDB在老年男性个体中是一种常见现象，会导致白天功能受损和整体生活质量下降。更重要的是，我们的数据表明，未经治疗的SDB可能会对患有睡眠呼吸紊乱的高血压个体的降压治疗效果产生不利影响。
