Andreas W. Schreib , Michael Arzt , Iris M. Heid , Bettina Jung , Carsten A. Böger , Stefan Stadler , the DIACORE study group
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引用次数: 0
Abstract
Background
Due to its prognostic importance for patients with type 2 diabetes (DM2), current guidelines recommend a systolic <130 mm Hg and diastolic <80 mm Hg blood pressure target. Periodic breathing, a form of sleep-disordered breathing, acutely causes repetitive hypoxia, sympathetic nervous system activation as well as oscillations of heart rate and blood pressure. However, limited data on the association of periodic breathing and control of blood pressure (BP) in patients with DM2 are available. Thus, the aim of the present study was to assess whether there is an association between periodic breathing and increased BP above the recommended target in DM2.
Methods
Cross-sectional data of 679 patients with DM2 from the DIACORE-SDB sub-study were analysed for association of periodic breathing with BP. Sleep-disordered breathing was assessed with a 2-channel ambulatory monitoring device including validated automatic pattern recognition for periodic breathing. BP values were determined in a standardized manner with three repeated measurements at rest.
Results
Of the 679 analysed individuals (61% male, age 66 ± 9 years, Body Mass Index [BMI] 31.0 ± 5.4 kg/m2), 11% had periodic breathing. Patients with periodic breathing had significantly higher systolic BP values (144 ± 19 mm Hg vs. 137 ± 18 mm Hg, p = 0.003). Multivariable regression analysis revealed that periodic breathing was associated with higher systolic BP (B [95% confidence interval, CI] = 4.4 [0.1; 8.7], p = 0.043) and not meeting the recommended BP target for patients with diabetes (<130/80 mmHg) (odds ratio, OR [95%CI] = 2.1 [1.1; 4.0], p = 0.026) independent of sex, age, high density lipoproteins, renal function, coronary heart disease and antihypertensive treatment.
Conclusion
Periodic breathing is associated with higher systolic BP in patients with DM2.
背景:由于其对2型糖尿病(DM2)患者预后的重要性,目前的指南推荐收缩压目标值为130 mm Hg,舒张压目标值为80 mm Hg。周期性呼吸是睡眠呼吸紊乱的一种形式,它会严重导致反复缺氧、交感神经系统激活以及心率和血压的波动。然而,关于周期性呼吸与DM2患者血压(BP)控制之间关系的数据有限。因此,本研究的目的是评估周期性呼吸与血压升高高于DM2推荐目标之间是否存在关联。方法分析DIACORE-SDB亚研究中679例DM2患者的横断面数据,分析周期性呼吸与BP的相关性。使用双通道动态监测设备评估睡眠呼吸障碍,包括经过验证的周期性呼吸自动模式识别。血压值以标准化的方式确定,静息时进行三次重复测量。结果679例患者(男性61%,年龄66±9岁,身体质量指数[BMI] 31.0±5.4 kg/m2)中,11%有周期性呼吸。周期性呼吸患者的收缩压值明显较高(144±19 mm Hg vs 137±18 mm Hg, p = 0.003)。多变量回归分析显示,周期性呼吸与较高的收缩压相关(B[95%置信区间,CI] = 4.4 [0.1;8.7], p = 0.043),未达到糖尿病患者推荐的血压目标(<130/80 mmHg)(优势比,OR [95%CI] = 2.1 [1.1;4.0], p = 0.026),与性别、年龄、高密度脂蛋白、肾功能、冠心病及降压治疗无关。结论DM2患者周期性呼吸与收缩压增高有关。