폐쇄성 수면 무호흡-저호흡증후군 환자에서 과도한 주간졸음증과 혈압 사이의 연관성
The Association between Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome
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초록
수면무호흡-저호흡를 가지고 있는 환자에서 과도한 주간졸음증의 표현형과 혈압 사이의 관계를 조사하고자 한다. 환자는 수면다원검사 결과에 따른 무호흡-저호흡지수가 5미만인 그룹은 코골이 그룹(n=108), 5∼15 사이는 경도 무호흡 그룹(n=186), 15∼30 사이는 중증도 무호흡 그룹(n=179), 30 이상인 그룹은 중증 무호흡그룹(n=233)으로 나누었다. 혈압 측정은 검사 시작 전과 후에 똑바로 누운 자세에서 3분 간격으로 2회 측정 후 평균값으로 야간 혈압과 아침 혈압을 측정하였다. 주간졸음증군과 비주간졸음증군의 수면 파라미터와 혈압과의 상관관계를 측정하였다. 수면 파리미터와혈압과의 이변량 상관관계에서 평균 동맥혈압과 체질량지수, 무호흡-저호흡지수, 총 각성지수는 양의 상관관계로 나타났고(r=0.099, r=0.142, r=0.135, p＜0.01, p＜0.01, p＜0.01), 최저산소포화도는 음의 상관관계로 나타났다(r=‒0.258, p＜0.01). 주간졸음증군은비주간졸음증군에 비해 나이가 어리고(47.2±11.3 vs 50.3±11.4, p=0.023), 이완기 혈압이 높고(야간 이완기혈압과 아침 이완기혈압, 83.1±9.7 vs 81.4±8.8, 86.4±9.2 vs 83.6±9.7)(p=0.031, p=0.047), 수축기혈압도 높았다(야간 수축기혈압, 아침 수축기혈압, 126.7±11.2 vs 123.4±12.4, 128.9±12.4 vs 125.3±12.9) (p=0.021, p=0.021). 무호흡-저호흡를 가지고 있으면서 고혈압이있고, 주간졸음증을 함께 가지고 있는 그룹은 그렇지 않은 그룹에비해 나이가 어리고, 총 각성숫자가 높고, 아침과 야간 수축기 및 이완기혈압이 높았다(p＜0.005, p=0.008, p＜0.001, p＜0.001). 결론적으로 주간졸음증의 표현형은 나이가 어리고, 아침 및 야간 수축기혈압과 이완기혈압이 높고, 수면 중 산소포화도가 더 떨어졌다.
Abstract
The purpose of this study was to investigate the relationship between excessive daytime sleepiness (EDS) and blood pressure (BP) in patients with obstructive sleep apnea-hypopnea (OSAH). Patients were classified into four groups based on their severity of polysomnographic data: the snoring group (n=108)—characterized by Apnea-Hypopnea Index (AHI＜5); the mild OSA group (n=186)—AHI 5≤AHI＜15; the moderate OSA group (n=179)— AHI 15≤AHI＜30; and the severe OSA group (n=233)—AHI≥30. On the same night of polysomnography (PSG), BP levels were measured before sleeping (bedtime BP) and immediately after waking up on the following morning (morning BP). EDS was recognized as ESS (epworth sleepiness scale)≥9. The differences and correlations between BP and PSG parameters in the EDS and non-EDS groups of OSAH patients were analyzed. MAP was positively correlated with BMI, AHI, and total arousal (r=0.099, r=0.142, r=0.135, p＜0.01, p＜0.01, p＜0.01), while negatively correlated with mean SaO2 (r=–0.258, p＜0.01). The EDS group had overall younger population (47.2±11.3 vs 50.3±11.4, p=0.023), higher DBP (both bedtime and morning, 83.1±9.7 vs 81.4±8.8 and 86.4±9.2 vs 83.6±9.7)(p=0.031, p=0.047), and higher SBP (both bedtime and morning, 126.7±11.2 vs 123.4±12.4, 128.9±12.4 vs 125.3±12.9)(p=0.021, p=0.021) than compared with the non-EDS group. In hypertensive OSAH patients, patients with EDS were also younger and had higher total arousal number, as well as higher morning and bedtime DBP and SBP than compared with the non-EDS group (p＜0.005, p=0.008, p＜0.001 and p＜0.001). EDS in OSAHS patients is a special phenotype characterized by younger age, higher DBP, more severe desaturation, and hypertension.
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