Population-based study of sleep-disordered breathing as a risk factor for hypertension.
Population-based study of sleep-disordered breathing as a risk factor for hypertension.
复制标题
DOI：
10.1001/archinte.1997.00440360178019
复制
发表时间：
1997-08
影响因子：
--
通讯作者：
T. Young;P. Peppard;M. Palta;K. Hla;L. Finn;B. Morgan;J. Skatrud
中科院分区：
文献类型：
--
作者：
T. Young;P. Peppard;M. Palta;K. Hla;L. Finn;B. Morgan;J. Skatrud
临床观察显示，睡眠呼吸障碍（睡眠期间反复出现呼吸暂停和呼吸不足）与高血压有关，但缺乏独立相关性的证据。了解这种关系很重要，因为睡眠呼吸障碍在成年人中的患病率很高。目的检验睡眠呼吸障碍与血压升高相关的假设，而不受混杂因素的影响。方法：样本包括1060名年龄在30岁到60岁之间的在职女性和男性，他们完成了威斯康星州睡眠队列研究的一项夜间方案。实验室内多导睡眠图用于确定睡眠障碍性呼吸状态，量化为每小时睡眠呼吸暂停和呼吸不足的次数（呼吸暂停-呼吸不足指数）。在进行多导睡眠描记术的夜晚测量血压。结果血压随着呼吸暂停低通气指数的增加而线性增加（收缩压P = 0.003，舒张压P = 0.01，校正混杂因素）。线性相关的幅度随着肥胖的减少而增加。当体重指数（体重（千克）除以身高（米）的平方）为30 kg/m2时，呼吸暂停低通气指数为15（vs 0）与收缩压升高3.6 mm Hg（95%置信区间，1.3-6.0）和舒张压升高1.8 mm Hg（95%置信区间，0.3-3.3）相关。与呼吸暂停低通气指数15（vs 0）相关的高血压的比值比为1.8（95%置信区间，1.3-2.4）。结论：睡眠呼吸障碍与血压之间存在剂量反应关系，与已知的混杂因素无关。如果是因果关系，那么睡眠呼吸障碍的高患病率可以解释美国大量成年人的高血压。
BACKGROUND Clinical observations have linked sleep-disordered breathing, a condition of repeated apneas and hypopneas during sleep, with hypertension but evidence for an independent association has been lacking. Understanding this relationship is important because the prevalence of sleep-disordered breathing is high in adults. OBJECTIVE To test the hypothesis that sleep-disordered breathing is related to elevated blood pressure independent of confounding factors. METHODS The sample included 1060 employed women and men aged 30 through 60 years who had completed an overnight protocol as part of the Wisconsin Sleep Cohort Study. In-laboratory polysomnography was used to determine sleep-disordered breathing status, quantified as the number of apneas and hypopneas per hour of sleep (apnea-hypopnea index). Blood pressure was measured on the night polysomnography was performed. RESULTS Blood pressure increased linearly with increasing apnea-hypopnea index (P = .003 for systolic, P = .01 for diastolic, adjusted for confounding factors). The magnitude of the linear association increased with decreasing obesity. At a body mass index (weight in kilograms divided by the square of the height in meters) of 30 kg/m2, an apnea-hypopnea index of 15 (vs 0) was associated with blood pressure increases of 3.6 mm Hg for systolic (95% confidence interval, 1.3-6.0) and 1.8 mm Hg for diastolic (95% confidence interval, 0.3-3.3). The odds ratio for hypertension associated with an apnea-hypopnea index of 15 (vs 0) was 1.8 (95% confidence interval, 1.3-2.4). CONCLUSIONS There is a dose-response relationship between sleep-disordered breathing and blood pressure, independent of known confounding factors. If causal, the high prevalence of sleep-disordered breathing could account for hypertension in a substantial number of adults in the United States.