Prospective study of the association between sleep-disordered breathing and hypertension
Prospective study of the association between sleep-disordered breathing and hypertension
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DOI：
10.1056/nejm200005113421901
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发表时间：
2000-05-11
影响因子：
158.5
通讯作者：
Skatrud, J
中科院分区：
文献类型：
--
作者：
Peppard, PE;Young, T;Skatrud, J
背景：睡眠障碍呼吸在普通人群中很普遍，在横断面流行病学研究中，睡眠障碍呼吸与慢性高血压有关。我们进行了一项基于人群的前瞻性研究，研究客观测量的睡眠障碍呼吸与高血压之间的关系(定义为实验室测量的血压至少为140/90毫米汞柱或使用降压药)。方法：我们分析了威斯康星州睡眠队列研究的709名参与者的睡眠障碍呼吸、血压、习惯和健康史的数据，并在四年后进行了跟踪(其中184名参与者进行了八年的随访)。受试者整夜接受18通道多导睡眠图对睡眠障碍呼吸的评估，根据呼吸暂停-低呼吸指数(每小时睡眠中呼吸暂停和低呼吸发作的次数)来定义。根据基线上的呼吸暂停低通气指数，在调整基线高血压状况、体重指数、颈围和腰围、年龄、性别、每周饮酒和吸烟后，根据基线上的呼吸暂停低通气指数估算四年随访时出现高血压的优势比。结果：相对于基线上每小时0个事件的呼吸暂停低通气指数参考类别，随访时出现高血压的优势比为1.42(95%可信区间，2.03(95%可信区间，1.29至3.17)，其呼吸暂停-低呼吸指数为每小时5.0至14.9事件/小时，以及2.89(95%可信区间，1.46至5.64)，呼吸暂停低通气指数每小时15.0次或以上。结论：我们发现基线睡眠障碍呼吸与四年后高血压的存在之间存在剂量-反应关系，且与已知的混杂因素无关。研究结果表明，睡眠呼吸障碍很可能是普通人群中高血压和随之而来的心血管疾病的一个危险因素。(N Engl J Med 2000；342：1378-84)(C)2000年，马萨诸塞州医学会。
Background: Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the association between objectively measured sleep-disordered breathing and hypertension (defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications).Methods: We analyzed data on sleep-disordered breathing, blood pressure, habitus, and health history at base line and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study (and after eight years of follow-up in the case of 184 of these participants). Participants were assessed overnight by 18-channel polysomnography for sleep-disordered breathing, as defined by the apnea-hypopnea index (the number of episodes of apnea and hypopnea per hour of sleep). The odds ratios for the presence of hypertension at the four-year follow-up study according to the apnea-hypopnea index at base line were estimated after adjustment for base-line hypertension status, body-mass index, neck and waist circumference, age, sex, and weekly use of alcohol and cigarettes.Results: Relative to the reference category of an apnea-hypopnea index of 0 events per hour at base line, the odds ratios for the presence of hypertension at follow-up were 1.42 (95 percent confidence interval, 1.13 to 1.78) with an apnea-hypopnea index of 0.1 to 4.9 events per hour at base line as compared with none, 2.03 (95 percent confidence interval, 1.29 to 3.17) with an apnea-hypopnea index of 5.0 to 14.9 events per hour, and 2.89 (95 percent confidence interval, 1.46 to 5.64) with an apnea-hypopnea index of 15.0 or more events per hour.Conclusions: We found a dose-response association between sleep-disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors. The findings suggest that sleep-disordered breathing is likely to be a risk factor for hypertension and consequent cardiovascular morbidity in the general population. (N Engl J Med 2000;342:1378-84.) (C)2000, Massachusetts Medical Society.