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首页> 美国卫生研究院文献>International Journal of Medical Sciences >The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome
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The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

机译：阻塞性睡眠呼吸暂停低通气综合征患者白天过度嗜睡的表型与血压之间的关系

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>Objective Investigate the clinical features and the blood pressure (BP) pattern of the phenotype of excessive daytime sleepiness (EDS) in OSAHS.>Methods A total of 508 Chinese adults with suspected OSAHS were referred to our sleep laboratory from October 2009 to May 2012. On the same night of polysomnography (PSG), the levels of blood pressure were measured before sleeping (bedtime BP) and immediately after waking up in the next morning (morning BP). EDS was recognized as Epworth Sleepiness Scale (ESS)≥9. Subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control (simple snoring) group (control, n=104) with AHI<5; mild group (mild, n=89) with AHI≥5 and <15; moderate group (moderate, n=70) with AHI≥15 and<30; and severe group (severe, n=245) with AHI ≥30. The differences and correlations between BP and PSG parameters in EDS and non-EDS group of OSAHS patients were analyzed.>Results In all subjects, ESS was positively correlated with morning diastolic blood pressure (DBP), Mean arterial pressure (MAP) and bedtime DBP (r=0.144, 0.102 and 0.114, respectively, each P value<0.05). In OSAHS patients, ESS was only positively correlated with morning DBP (r=0.137, P<0.05). OSAHS patients with EDS phenotype were younger and were more likely to have the symptom of waking up feeling tired (36.1% vs. 23.2%, p=0.023), who had lower MSaO2, longer SIT90 (the ratio of time of SpO2 below 90% in total sleep time) and higher DBP (bedtime as well as morning). In patients with AHI≥15, ESS was correlated positively with both bedtime and morning DBP after controlling the confounding effects of age, sex, BMI, AHI and nadir nocturnal oxygen saturation( r=0.126,0.143, respectively, both P values<0.05). And in OSAHS patients of EDS phenotype, the bedtime DBP, bedtime MAP, morning DBP, and morning MAP were 3~5 mm Hg higher than that in patients of non-EDS phenotype(P<0.05). In the moderate and severe OSAHS group, patients with EDS phenotype were younger and had a lower mean blood oxygen saturation (MSaO2), longer time of SpO2 below 90% and higher SIT90 than patients with non-EDS phenotype (P<0.05). In hypertensive OSAHS patients, patients with EDS were also younger and had higher micro-arousal index (MiI), as well as higher morning DBP, morning MAP and bedtime DBP than that in non-EDS group (P<0.05).>Conclusions EDS in OSAHS patients is a special phenotype, which was characterized by younger age, higher DBP and more severe hypoxic load. This feature is mainly manifested in moderate and severe OSAHS patients. It is very important to identify the phenotype of EDS in patients with OSAHS, who may meet more benefits from effective treatment of OSAHS by correcting the intermittent nocturnal hypoxia and sleep fragmentation.
机译：>目的调查OSAHS中白天过度嗜睡（EDS）表型的临床特征和血压（BP）模式。>方法共有508名中国人疑似OSAHS于2009年10月至2012年5月转诊至我们的睡眠实验室。在多导睡眠监测（PSG）的同一晚，在睡眠前（就寝时间BP）和第二天早晨醒来后（早晨BP）测量了血压水平。 EDS被认为是Epworth嗜睡量表（ESS）≥9。根据来自PSG的呼吸暂停低通气指数（AHI）将受试者分为四组：对照组（简单打））组（对照组，n = 104），AHI <5； AHI≥5且<15的轻度组（轻度，n = 89）； AHI≥15且<30的中度组（中度，n = 70）； AHI≥30的严重组（重度，n = 245）。分析了EDS组和非EDS组OSAHS患者的BP和PSG参数之间的差异和相关性。>结果在所有受试者中，ESS与早晨舒张压（DBP），平均动脉压呈正相关（MAP）和就寝时间DBP（分别为r = 0.144、0.102和0.114，每个P值<0.05）。在OSAHS患者中，ESS与早晨DBP仅呈正相关（r = 0.137，P <0.05）。具有EDS表型的OSAHS患者较年轻，更容易出现疲倦的起床症状（36.1％比23.2％，p = 0.023），他们的MSaO2较低，SIT90较长（SpO2的时间比例低于90％）总睡眠时间）和更高的DBP（就寝时间和早晨）。 AHI≥15的患者在控制年龄，性别，BMI，AHI和最低点夜间血氧饱和度的混杂影响后，ESS与就寝时间和早晨DBP呈正相关（r分别为r = 1.126、0.143和P <0.05） 。在OSAHS EDS表型患者中，就寝时间DBP，就寝时间MAP，早晨DBP和早晨MAP比非EDS表型患者高3〜5 mm Hg（P <0.05）。在中度和重度OSAHS组中，与非EDS表型患者相比，具有EDS表型的患者较年轻，平均血氧饱和度（MSaO2）较低，SpO2低于90％的时间更长，SIT90较高（P <0.05）。与非EDS组相比，高血压OSAHS患者中EDS患者也更年轻，并且具有更高的微耳指数（MiI）以及更高的早晨DBP，早晨MAP和就寝时间DBP（P <0.05）。结论 OSAHS患者的EDS是一种特殊的表型，其特点是年龄较小，DBP较高且缺氧负荷更严重。此特征主要表现在中度和重度OSAHS患者中。识别OSAHS患者的EDS表型是非常重要的，他们可以通过纠正间歇性夜间低氧和睡眠破碎来从OSAHS的有效治疗中获得更多收益。

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