阻塞性睡眠呼吸暂停患者睡眠-呼吸事件诱发夜间血压升高与交感神经活动的关系

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Bo Sun, Zhengqing Mu, Yujiao Wan, Jiani Shen, Yujie Yuan, Xiaochen Xie, Zili Meng, Qiyun Ma, Jing Xu
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引用次数: 0

摘要

目的:夜间血压(BP)激增是交感神经过度活跃的阻塞性睡眠呼吸暂停(OSA)患者的特征性现象。本研究旨在探讨睡眠呼吸事件诱发的夜间血压升高与交感神经活动的关系。方法:根据纳入和排除标准,于2022年4月至2023年10月共纳入85例中度至重度OSA患者和44例对照组。连续监测夜间血压和心率变异性(HRV),并与多导睡眠图(PSG)同步。取夜间血压的平均值作为睡眠血压,取所有睡眠呼吸事件引起的最高血压的平均值作为睡眠峰值血压。夜间短期血压变异性(BPV)计算如下:事件相关收缩压升高(ΔSBP)为呼吸暂停后收缩压峰值与最低值之差,BP指数为30 s/h内ΔSBP≥12 mm Hg的个数,睡眠-呼吸事件引起的血压波动百分比(PBPF)为BP指数与呼吸暂停低通气指数之比。根据中位PBPF将OSA患者分为两个亚组(高、低血压浪涌组)。血浆去甲肾上腺素(NE)水平和HRV反映交感神经活动。比较各组的PSG和BP参数,分析夜间短期BPV与交感神经活动的相关性。结果:与对照组相比,OSA患者肥胖、血脂异常、交感神经过度活跃。与低血压波动组相比,高血压波动组交感神经活动更高,缺氧更严重。Pearson相关分析显示夜间短期血压升高与交感神经活动增加呈正相关(均P)。结论:睡眠呼吸事件诱发的夜间血压升高与中度至重度OSA患者交感神经活动呈正相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Relationship between sleep-breathing events induced nocturnal blood pressure surge and sympathetic nervous activity in patients with obstructive sleep apnea.

Objective: Nocturnal blood pressure (BP) surge is a characteristic phenomenon in patients with obstructive sleep apnea (OSA) associated with sympathetic nerve overactivity. This study aimed to explore the relationship between the sleep-breathing events induced nocturnal BP surge and sympathetic nerve activity.

Methods: A total of 85 patients with moderate-to-serve OSA and 44 controls were included in the study between April 2022 and October 2023 based on the inclusion and exclusion criteria. Full-night BP and heart rate variability (HRV) were monitored continuously and synchronized with polysomnography (PSG). The average of nocturnal BPs was taken as the asleep BP and the average of the highest BPs induced by all sleep-breathing events as the asleep peak BP. Nocturnal short-term BP variability (BPV) was calculated as follows: event-related systolic BP elevation (ΔSBP) as the gap between the peak and the lowest value of post-apneic SBP, BP index as the number of ΔSBP ≥ 12 mm Hg within 30 s/h, and the percentage of BP fluctuation induced by sleep-breathing events (PBPF) as the ratio of BP index and apnea-hypopnea index. Patients with OSA were divided into two subgroups (high- and low-BP surge groups) according to the median PBPF. The sympathetic nerve activity was reflected by plasma norepinephrine (NE) level and HRV. The PSG and BP parameters were compared among three groups, and the correlation between nocturnal short-term BPV and sympathetic nerve activity was analyzed.

Results: Patients with OSA were fatter and suffered from dyslipidemia and sympathetic nerve overactivity compared to controls. The high-BP surge group displayed higher sympathetic nerve activity and more severe hypoxia compared with the low-BP surge group. The Pearson correlation analysis showed a positive correlation of the higher nocturnal short-term BPV with increased sympathetic nerve activity (all P < 0.05). After excluding confounding factors, such as age, body mass index, and smoking history, the multiple linear regression revealed a positive correlation of the LF/HF (ratio of low-frequency to high-frequency power, indicating the activity of sympathetic nerve activity) with the BP index (β = 7.337, P < 0.001), ΔSBP (β = 2.797, P < 0.001), and PBPF (β = 9.036, P < 0.001). The plasma NE level also had a positive correlation with the BP index (β = 3.939, P = 0.022) and PBPF (β = 8.752, P < 0.001).

Conclusion: The sleep-breathing events induced nocturnal BP surge was positively correlated with sympathetic nerve activity in patients with moderate-to-serve OSA.

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来源期刊
Sleep and Breathing
Sleep and Breathing 医学-呼吸系统
CiteScore
5.20
自引率
4.00%
发文量
222
审稿时长
3-8 weeks
期刊介绍: The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.
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