혈압과 폐쇄성수면무호흡-저호흡증후군의 연관성
The Association between Blood Pressure and Obstructive Sleep Apnea-Hypopnea Syndrome
1
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Obstructive sleep apnea-hypopnea (OSAH) is known to be related to nocturnal blood pressure (BP) and hypertension. The aim of this study was to evaluate the prevalence of hypertension according to the apnea-hypopnea grading. A total of 2,210 adults with snoring and obstructive sleep apnea were referred to our sleep center from July 2009 to May 2013. Clinical blood pressure (BP) was measured before sleeping (bedtime BP) and immediately after waking up in the next morning (morning BP). Subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control group (n=470) simple snoring and with AHI＜5; mild group (n=577) with AHI≥5 and ＜15; moderate group (n=508) AHI≥15 and ＜30; and severe group (n=655) with AHI≥30. The differences and correlations between BP and PSG parameters according to the AHI groups were analyzed. Patient's were classified as nomentensive (blood pressure ＜120/90 mmHg, n=700 ), prehypertensive (blood pressure ＜140-120≤mmHg, n=1297) hypertensive (blood pressure ≥140/90 mmHg, n=214) according to the office blood pressure measurements. The comparison of sleep parameters showed that OSA groups had a significantly higher stage N1 (control group vs. moderate OSA, severe OSA; 66.4±30.7 vs. 85.5±36.6, 128.4±57.3, p＜0.001) and total arousal number (control vs. moderate OSA, severe OSA; 110.7±47.7 vs. 150.8±56.6, 236.6±95.8, p＜0.001) compared to control group. The comparison of sleep parameters showed that OSA groups had a significantly lower stage N2 (control group vs. moderate OSA, severe OSA; 172.6±47.2 vs. 150.7±50.5, 120.3±57.4, p＜0.001), stage N3 (control group vs. moderate OSA, severe OSA; 38.4±33.4 vs. 27.4±26.0, 56.1±27.5, p＜0.001), REM (control group vs. moderate OSA, severe OSA; 64.3±25.5 vs. 56.1±27.5, 47.3±25.9, p＜0.001) and mean SaO2% (control group vs. moderate OSA, severe OSA; 90.0±3.5 vs. 82.5±5.5, 70.0±8.8, p＜0.001) compared to control group. The Apnea-hypopnea index was significantly higher in OSA groups, increased systolic and diastolic blood pressure than in the nomentensive group (bed time systolic pressure vs. AHI; ＜120 vs. 120-139, 140-159, ＞159; 17.5±18.6 vs. 24.9±21.0, 31.0±25.7, 42.3±31.7, p＜0.001), (bed time diastolic pressure vs. AHI; 60-79 vs. 80-89, 90-99, ＞99; 19.3±19.7 vs. 22.4±20.3, 29.8±23.3, 38.8±28.5, p＜0.001). AHI was positively correlated with morning systolic pressure, diastolic pressure, bed time systolic pressure and diastolic pressure (r=0.314, 0.279, 0.233 and 0.200, respectively, p＜0.001). We conclude that BMI, Age, neck circumference and AHI increase with the blood pressure.
Abstract
Obstructive sleep apnea-hypopnea (OSAH) is known to be related to nocturnal blood pressure (BP) and hypertension. The aim of this study was to evaluate the prevalence of hypertension according to the apnea-hypopnea grading. A total of 2,210 adults with snoring and obstructive sleep apnea were referred to our sleep center from July 2009 to May 2013. Clinical blood pressure (BP) was measured before sleeping (bedtime BP) and immediately after waking up in the next morning (morning BP). Subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control group (n=470) simple snoring and with AHI＜5; mild group (n=577) with AHI≥5 and ＜15; moderate group (n=508) AHI≥15 and ＜30; and severe group (n=655) with AHI≥30. The differences and correlations between BP and PSG parameters according to the AHI groups were analyzed. Patient's were classified as nomentensive (blood pressure ＜120/90 mmHg, n=700 ), prehypertensive (blood pressure ＜140-120≤mmHg, n=1297) hypertensive (blood pressure ≥140/90 mmHg, n=214) according to the office blood pressure measurements. The comparison of sleep parameters showed that OSA groups had a significantly higher stage N1 (control group vs. moderate OSA, severe OSA; 66.4±30.7 vs. 85.5±36.6, 128.4±57.3, p＜0.001) and total arousal number (control vs. moderate OSA, severe OSA; 110.7±47.7 vs. 150.8±56.6, 236.6±95.8, p＜0.001) compared to control group. The comparison of sleep parameters showed that OSA groups had a significantly lower stage N2 (control group vs. moderate OSA, severe OSA; 172.6±47.2 vs. 150.7±50.5, 120.3±57.4, p＜0.001), stage N3 (control group vs. moderate OSA, severe OSA; 38.4±33.4 vs. 27.4±26.0, 56.1±27.5, p＜0.001), REM (control group vs. moderate OSA, severe OSA; 64.3±25.5 vs. 56.1±27.5, 47.3±25.9, p＜0.001) and mean SaO2% (control group vs. moderate OSA, severe OSA; 90.0±3.5 vs. 82.5±5.5, 70.0±8.8, p＜0.001) compared to control group. The Apnea-hypopnea index was significantly higher in OSA groups, increased systolic and diastolic blood pressure than in the nomentensive group (bed time systolic pressure vs. AHI; ＜120 vs. 120-139, 140-159, ＞159; 17.5±18.6 vs. 24.9±21.0, 31.0±25.7, 42.3±31.7, p＜0.001), (bed time diastolic pressure vs. AHI; 60-79 vs. 80-89, 90-99, ＞99; 19.3±19.7 vs. 22.4±20.3, 29.8±23.3, 38.8±28.5, p＜0.001). AHI was positively correlated with morning systolic pressure, diastolic pressure, bed time systolic pressure and diastolic pressure (r=0.314, 0.279, 0.233 and 0.200, respectively, p＜0.001). We conclude that BMI, Age, neck circumference and AHI increase with the blood pressure.
참고문헌 (19)
- Baguet JP, "Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients", J Hypertension, 23, pp.521~527 (2005)
- Calhoun DA, "Resistant hypertension: diagnosis, evaluation and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research", Hypertension, 51, pp.1403~1419 (2008)
- Darne B, "Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality", Hypertension, 13, pp.392~400 (1989)
- Drager LF, "Obstructive sleep apnea, masked hypertension, and arterial stiffness in men", J Hypertension, 23, pp.249~254 (2010)
- Drager LF, "Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension", Am J Cardiol, 105, pp.1135~1139 (2010)
- Fletcher EC, "Undiagnosed sleep apnea in patients with resistant hypertension", Ann Intern Med, 103, pp.190~195 (1985)
- Gislason T, "Prevalence of sleep apnea syndrome among Swedish men-an epidemiological study", J Clin Epidemiol, 4, pp.571~576 (1988)
- Haentjens P, "The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials", Arch Intern Med, 67, pp.757~764 (2007)
- Iber C, "The AASM manual for the scoring of sleep and associated event : rules, terminology and technical specifications" (2007), American Academy of Sleep Medicine
- IP MS, "A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong", Chest, 119, pp.62~69 (2001)
- Kripke DF, "Prevalence of sleep-disordered breathing in ages 40-64 years: a population-based survey", Sleep, 20, pp.65~76 (1997)
- Lavie P, "Prevalence of sleep apnea syndrome among patients with essential hypertension", Am Heart J, 108, pp.373~376 (1984)
- Mo L, "Effect of long-term continuous positive airway pressure ventilation on blood pressure in patients with obstructive sleep apnea hypopnea syndrome: a meta-analysis of clinical trials", Zhonghua Yi Xue Za Zhi, 87, pp.1177~1180 (2007)
- Narkiewicz K, "Nocturnal Acontinuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea", Circulation, 100, pp.2332~2335 (1999)
- Nieto FJ, "Association of sleep-disordered breathing sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study", JAMA, 283, pp.1829~1836 (2000)
- Olson LG, "A community study of snoring and sleep-disordered breathing prevalence", Am J Respir Crit Care Med, 152, pp.711~716 (1995)
- "Prevalence of Sleep-disordered Breathing in Middle-aged Korean Men and Women", Am J Respir Crit Care Med, 170, pp.1108~1113 (2004)
- Somers VK, "Sympathetic neural mechanisms in obstructive sleep apnea", J Clin Invest, 96, pp.1897~1904 (1995)
- Worsnop CJ, "The prevalence of obstructive sleep apnea in hypertensives", Am J Respir Crit Care Med, 157, pp.111~115 (1998)