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A Study on Blood Pressure Variability in Sleep Apnea Population

Author: TangShuJin
Tutor: ChenBaoYuan
School: Tianjin Medical University
Course: Internal Medicine
Keywords: sleep apnea (SA) hypertension blood pressure variability hypoxia arousal mechanism
CLC: R56
Type: Master's thesis
Year: 2007
Downloads: 114
Quote: 1
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Abstract


Obstractive:①To study the influence of sleep apnea on blood pressure.②To assess whether sleep apnea is an independent influence factor forhigher blood pressure and blood pressure varability after controllingconfondering factors（such as age, gender, BMI, smoke, drink, et al）.③To explore the relationship between the state of oxygeon desatuationand blood pressure elevation or abnormal blood pressure variabilityin sleep hyponea.Methods:857 cases all come from the general hospital outpatient sleepclinical of Tan Jin Medical University. All subjects accepted the simplephysicial examination and filled in the same sleepquestionnaire. Performed the full nocturnal polysomnography and measuredthe blood pressure before subjects onset sleep and in the next morningat the moment awaken. Classfied all cases into four groups includedwithout SA、mild SA、moderate SA and severe SA. Compared the blood pressureand blood pressure variation among the groups and then analysised thecorrelation between them and sleep parameters. Chosed 217 cases from thesubjects who came to the clinic on the dates and mesure the blood pressurein the midnight.Categorized the 217 cases into hypertensive andnormotensive on the base of their blood pressures. Compare the decreasevalue of the blood pressure and then analysised the correlations.Result:①The blood pressure（SBP、DBP、MAP） of severe SA group weresignificanlly higher than the other three groups. MAP on the awakeningmoment decreased （1.74±9.03） mmHg（P=0.02） in the no SA group and （2.14±9.75） mmHg （P=0.002） in the mild SA group but increased （1.14± 10.48）mmHg（P=0.010）in the severe SA group and no significance in themoderate SA group. The increase value of blood pressure between afterawaken and before sleep was significantly higher than the other threegroups.②AHI could predict MAP before sleep and at the awake momentindependently. With AHI increased 1 time/h MAP before sleep increased0.098mmHg and MAP awaken increased 0.075mmHg.③AHI was significantlyhigher and minSaO2、MSaO2 were significantly lower inhypertensive than normotensive（P＜0.05）.④SBP before go to bed、SBP、DBP in midnight and SBP、DBP on awakening were all higher inhypertensive than nonhypertensive significantly（P＜0.05）.⑤The decreasevalue of blood pressure from before sleep to midnight（△SBP、△DBP、△MBP） were significantly lower in hypertensive than normotensive（P＜0.05）.⑥There were positive correlation between midnight SBP and AHI,age, BMI, between DBP and AHI, BMI and between midnight MAP and AHI、age、BMI. AHI could predict midnighte SBP、DBP、MAP independently, companied withAHI increased 1 time/h midnighte SBP increased 0.135mmHg, DBP increased0.099mmHg and MAP increased O. 109mmHg.⑦The analysis correlat ion ofdecrease of midnight blood pressure:There were negativecorrelation between△SBP（before onset sleep—midnight） with AHI, T90, andthere were positive correlation betwee△SBP（before onset sleep-midnight）with minSaO2、MSaO2. T90、minSaO2、and ANI could predict△SBP（before onsetsleep-midnight） independently.There was negative correlation between△DBP（awakening time—midnight） and Tg0 and here was positive correlationbetween△DBP（awakening time—midnight） and minSaO2.T90 and minSaO2 couldpredict△DBP（awakening time—midnight） independently.Conclusion:AHI was independent predict factor of MAP prior to onset of sleep and immediately on awakening, In no SA and mild SA blood pressurewas lower on awakening time but in severe SA morning blood pressure washigher.②AHI was higher in hypertensive than normotensive, and minSaO2、MSaO2 were lower. Especially midnight blood pressure decreased morelittle in hypertensive. T90, minSaO2、AHI were independent predictor ofnight blood pressure variability.③AHI was independent predictor ofmidnight blood pressure. Hypoxia、arousal and pleura] pressure changelargely result from sleep apnea maybe the etiology of sleep apneacompanied with hypertension.

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