《睡眠呼吸暂停相关心动减缓与晨起血压的关联性研究(英文》由会员分享，可在线阅读，更多相关《睡眠呼吸暂停相关心动减缓与晨起血压的关联性研究(英文（19页珍藏版）》请在金锄头文库上搜索。
1、Sleep Apnea associated- Bradycardia and the Morning Blood Pressure Xu QingRespiratory Dept. Wuhan Union HospitalBackgroundobstructive sleep apnea-hypopnea syndromeOSAHSApneaIntermittent HypoxemiaArousalSystemic HypertentionApnea associated-Bradycardia & Corresponding BP Fluctuations OSAHS Apnea asso
2、ciated-Bradycardia Time(s)Heart rate(bpm)A pre-event period B hypopnea C post-event recovery period HRBarbara J. Morgan, SLEEP, 1998, 21:737-746. ？HTHRVagal nerveSympathetic nerve ？BP elevated ？BPObjectiveJTo explore the relevance of SA associated-bradycardia to the morning blood pressureJ To invest
3、igate the role of vagal nervous system plays in OSAHS associated hypertensionSubjectsJ N104 OSAHS patientJ M:F 94:10J Symptoms J PE： BPJ Lab test polysomnography, PSGMethodsPSGrespiratory inductive plethysmography，RIPD areaRespitrace, Ambulatory Monitoring, SensorMedics co. America Parameters involv
4、edJAgeJBody Mass Index, BMI JApnea-Hypopnea Index, AHI JNocturnal Minimum of Arterial Oxygen Saturation, nSaO2minJPercentage of Dwell Time of Arterial Oxygen Saturation lower than 90%，DT90%JDeviation of Heart Rate, DHRJBlood PressureMAP=DBP+1/3(SBP-DBP)ResultsThe morning BP vs. Pre-sleep BPTable 1.
5、Comparison of the morning BP to Pre-sleep BP in 104 OSAHS patients x s，(median) ParameterPre-sleepMorningMorning - prestatisticP value SBP (mm Hg) 123.54 17.76 (120)128.30 17.89 (125)4.7910.87(4)- 4.1720.000*DBP (mm Hg) 81.96 9.61 (80)88.58 10.64 (88)6.62 7.37(8)- 6.9180.000*MAP (mm Hg) 95.82 11.50
6、(93.33)101.83 12.32 (100)6.01 7.76(5.33)- 7.8940.000* * P 0.01， Wilcoxon Rank sum test， Paired t test*Comparison betweenthe morning BP and the Pre-sleep BPFigure1. The morning BP (median) is elevatedcompared to the pre-sleep BP (* P0.01)020406080100120140Pre-sleep MorningBP(mm Hg)SBPDBPMAPConstructi
7、on of hypertension Relevance of DHR to the morning BPTable 2. Correlation test of SA associated DHR and BP pre-/post-sleepSBPbs (mm Hg)DBPbs (mm Hg)SBPas (mm Hg)DBPas (mm Hg)MAPbs (mm Hg)MAPas (mm Hg)DHR(bpm)r 0.0850.1630.1210.214 *0.1410.149P 0.3920.0970.2230.0290.1520.130* P 0.05， simple correlati
8、on analysis； rank correlation analysis. Relevance of DHR to the morning DBPDBP: diastolic blood pressureMorning DBPFigure 2. DHR is positive correlated with the morning diastolic blood pressure (r =0.214,P0.05).DHR (bpm)Relevance of DHR to the morning HTTable 3. Risk factors of hypertension by Logis
9、tic analysis in OSAHS patientsDependent variableRisk factorOR95% CIc 2P SHTasBMI1.0561.007 1.1094.950.026DHR1.2531.057 1.4866.7370.009Age1.1261.037 1.2227.9640.005DHTasBMI1.2441.076 1.4398.7080.003* P 0.01, P 0.05，SHTas: Systolic hypertension after sleep, the Morning SBP 140 mmHg, DHTas: diastolic h
10、ypertension after sleep , the Morning DBP90 mmHg ,Age、BMI、AHI、nSaO2%min 、DT90% and DHR as independent variable.SummaryJThe morning DBP is elevated remarkably in OSAHS patients compared with the SBPJSA associated-bradycardia is correlated with the morning diastolic blood pressureJThe amplitude of bradycardia during apnea (DHR) is an independent predictive factor of systolic HT next morningHYPOTHESIS？HTHRVagal nerveSympathetic nerve ？Elevated BP？BPTHANK YOU!
