＂Non-Dipping＂ Blood Pressure and Excessive Daytime Sleepiness in Severe Obstructive Sleep Apnea

嚴重阻塞性睡眠呼吸中止症病人日間嗜睡以及夜間血壓下降幅度減少之關係探討

張哲嘉(Che-Chia Chang) ； 莊立邦(Li-Pang Chuang) ； 林育聖(Yu-Sheng Lin) ； 林士為(Shih-Wei Lin) ； 李忠恕(Chung-Shu Lee) ； 張志豪(Chih-Hao Chang) ； 陳濘宏(Ning-Hung Chen)

《胸腔醫學》 30卷5期 (2015/10) Pp. 261-270

摘要

前言：一般人夜間血壓會比日間降低至少10%，夜間血壓下降幅度減少為心血管疾病的危險因子。阻塞性睡眠呼吸呼吸中止症也被廣泛認為是心血管疾病的危險因子。而夜間血壓降低幅度減少也有研究顯示與阻塞性睡眠呼吸中止症相關。然而針對阻塞性睡眠呼吸中止症病人中夜間血壓下降幅度減少的盛行率及可能發生原因之探討目前文獻資料仍然相當有限。而日間嗜睡為阻塞性睡眠呼吸中止症之常見表徵，但是與夜間血壓下降幅度減少之關係仍未被討論。因此本研究及針對阻塞性睡眠呼吸中止症病人日間嗜睡以及夜間血壓降低幅度減少之關係作探討。方法：本研究為前瞻性研究，收集2010年11月至2013年5月間，因打呼至睡眠門診求診之高血壓之病人。病人皆安排接受完整睡眠檢查以及24小時活動式血壓計測量。排除高血糖及已接受高血壓治療之病人。探討病人夜間血壓降低幅度減少之盛行率，以及與日間嗜睡狀況之關係。結果：共有53位高血壓之重度阻塞性睡眠呼吸中止症之患者加入研究。其中23人為夜間血壓降幅減少之病人，佔全體43%。夜間血壓降幅減少與性別、體重、無呼吸－低呼吸指數（AHI）、夜間血氧狀態、日間血壓狀態無關。夜間血壓降幅減少之病人有較低的夜間血壓（p值=0.017）以及較高的比例有日間嗜睡的狀態（嗜睡問卷分數大於或等於10分）（p值=0.045）。夜間血壓降低之幅度也與嗜睡問卷分數呈線性負相關。經過回歸分析嗜睡問卷分數為夜間血壓降低之幅度之獨立的預測因子（p值=0.022, R2=0.099, 95信賴區間=-0.009-0.000）。結論：夜間血壓降低幅度減少之情形於嚴重阻塞型呼吸中止症之病人中有較高的發生率。而這些病人有較多日間嗜睡之情形，日間嗜睡之問卷分數為夜間血壓降幅之獨立因子。於這些有較高之心血管風險之病人，24小時活動式血壓計的血壓測量有重要臨床意義。

關鍵字

夜間血壓下降 ； 夜間血壓下降幅度正常者 ； 夜間血壓下降幅度減少者 ； 日間嗜睡 ； 睡眠呼吸中止症 ； 高血壓 ； 動態血壓測量

並列摘要

Background: Non-dipping blood pressure and obstructive sleep apnea both carry an increased risk of cardiovascular events and mortality. The relationship between non-dipping blood pressure and obstructive sleep apnea has been noted. However, data on the prevalence of sleep apnea with non-dipping hypertension and the relationship with excessive daytime sleepiness are limited. Objective: The purpose of the present study was to determine the prevalence of nondipping blood pressure and evaluate the relationship with excessive daytime sleepiness. Patients and Methods: We prospectively enrolled adult patients with habitual snoring who visited our sleep clinics from November 2010 to May 2013. Polysomnography and 24-hour ambulatory blood pressure monitoring (ABPM) were used. Excessive daytime sleepiness was evaluated. The prevalence of non-dipping blood pressure and the relationship with excessive daytime sleepiness were evaluated. Results: Thirty patients were dippers (57%) and 23 (43%) were non-dippers. Nondippers had lower nighttime blood pressure and more excessive daytime sleepiness (Epworth sleepiness scale (ESS) ≥10) than dippers (p=0.045). ESS was significantly negatively correlated with dipping of systolic and diastolic blood pressure and mean arterial pressure, R=-0.313, -0.304, -0.302, respectively (p ＜ 0.05). Multivariate linear regression models for associations involving systolic blood pressure dipping showed that ESS was the only independent predictor of systolic blood pressure dipping [β=-0.005, p=0.022, R^2=0.099, 95% confidence interval (CI) of β=-0.009-0.000] in stepwise linear regression analyses. Conclusions: High prevalence of non-dippers was noted in severe obstructive sleep apnea patients. Non-dippers experienced more excessive daytime sleepiness. ESS was an independent predictor of dipping values. ABPM may play an important role in these high cardiovascular risk groups.

並列關鍵字

nocturnal blood pressure dipping ； dipper ； non-dipper ； excessive daytime sleepiness ； obstructive sleep apnea ； hypertension ； ambulatory blood pressure monitoring