Obstructive sleep apnea and diurnal nondipping hemodynamic indices in patients at increased cardiovascular risk.
Obstructive sleep apnea and diurnal nondipping hemodynamic indices in patients at increased cardiovascular risk.
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DOI：
10.1097/hjh.0000000000000011
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发表时间：
2014-02
影响因子：
4.9
通讯作者：
Mehra R
中科院分区：
文献类型：
--
作者：
Seif F;Patel SR;Walia HK;Rueschman M;Bhatt DL;Blumenthal RS;Quan SF;Gottlieb DJ;Lewis EF;Patil SP;Punjabi NM;Babineau DC;Redline S;Mehra R
我们假设阻塞性睡眠呼吸暂停（OSA）严重程度的增加与心血管疾病（CVD）风险增加中的非下降血压（BP）相关。对298例心脏病患者的基线数据进行了多中心随机对照试验。下降被定义为睡眠相关的血压或心率（HR）降低至少10%。Logistic回归模型进行拟合，调整年龄，性别，种族，BMI，CVD危险因素，CVD和研究地点。呼吸暂停低通气指数（AHI）和氧减饱和指数（ODI）每增加1个单位，非收缩压下降的几率增加4%，具有统计学意义。AHI和非倾斜平均动脉压（MAP）之间没有显著关系;然而，ODI每增加1个单位，非倾斜MAP的比值增加3%（比值比，OR =1.03; 95%置信区间，CI 1.00-1.05）。在重度OSA水平，观察到AHI和ODI每增加1个单位，非下降DBP的几率分别增加10%和4%。ODI每增加一次，观察到非倾斜HR比值增加6% [OR =1.06; 95% CI（1.01-1.10）]，直至ODI的上四分位数。在有心血管风险和中重度OSA的患者中，AHI和/或ODI增加与SBP和MAP非下降的几率增加相关。更严重的AHI和ODI水平也与非下降DBP相关。这些结果支持与OSA严重程度增加相关的渐进性BP负担，即使在心脏病学专科护理管理的患者中也是如此。
We hypothesized increasing obstructive sleep apnea (OSA) severity would be associated with nondipping blood pressure (BP) in increased cardiovascular disease (CVD) risk. Baseline data from 298 cardiology patients recruited for a multicenter randomized controlled trial were examined. Dipping was defined as a sleep-related BP or heart rate (HR) reduction of at least 10%. Logistic regression models were fit, adjusting for age, sex, race, BMI, CVD risk factors, CVD, and study site. There was a statistically significant 4% increase in the odds of nondipping SBP per 1-unit increase in both Apnea Hypopnea Index (AHI) and Oxygen Desaturation Index (ODI). There was no significant relationship between AHI and nondipping mean arterial pressure (MAP); however, a 3% increase in the odds of nondipping MAP per 1-unit increase in ODI was observed (odds ratio, OR =1.03; 95% confidence interval, CI 1.00–1.05). At severe OSA levels, a 10 and 4% increase in odds of nondipping DBP per 1-unit increase in AHI and ODI were observed, respectively. A 6% [OR =1.06; 95% CI (1.01–1.10)] increase in nondipping HR odds was observed with each increase in ODI until the upper quartile of ODI. In patients at cardiovascular risk and moderate-to-severe OSA, increasing AHI and/or ODI were associated with increased odds of nondipping SBP and nondipping MAP. More severe levels of AHI and ODI also were associated with nondipping DBP. These results support progressive BP burden associated with increased OSA severity even in patients managed by cardiology specialty care.