Plasma Adrenomedullin In Relevant To Obstructive Sleep Apnea-hypopnea Syndrome And Hypertension

Objective:To investigate the variation level of plasma adrenomedullin in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with hypertension and research the effect of body mass index (BMI), neck circumference, waist circumference, oxyhemoglobin desaturation, apnea-hypopnea index and blood pressure on the expression of adrenomedullin in peripherial blood, to reveal the possible mechanism of hypertension in patients with obstructive sleep apnea-hypopnea syndrome and provided the treatment strategy for OSAHS combined with hypertension. Methods:Total of 261 subjects were recruited in this study and divided into four groups (healthy volunteer, A1B1 group, n=56; hypertension without OSAHS, A1B2 group n=52; OSAHS without hypertension, A2B1 group n=66; OSAHS combined with hypertension, A2B2 group n=87) according to the diagnosis criterion of OSAHS and hypertension. All of them received the sleep monitoring with PSG monitoring unit and ADM expression in peripherial blood were measured by Radioimmunoassay. Results:(1) Comparison of oxyhemoglobin desaturation, apnea-hypopnea index (AH1) and ADM in different groups:The AHI and ADM in OSAHS without hypertension and OSAHS combined with hypertension patients were significantly higher compared with hypertension without OSAHS patients and healthy volunteers, but the oxyhemoglobin desaturation in OSAHS without hypertension and OSAHS combined with hypertension patients markedly lower than those in hypertension without OSAHS patients and healthy volunteers. However, there was no difference of ADM between OSAHS without hypertension and OSAHS combined with hypertension patients; (2) Results of the OSAHS and HBP influence on the ADM in blood with factorial design:With analysis of variance of factorial design, the HBP on the ADM level had no effect (F=0.031, P=0.861), the OSAHS on the ADM had a statistically significant effect (F=28.257, P=0.000), between HBP and OSAHS without interaction (F=1.734,P=0.189). (3) The correlation of ADM with body mass index (BMI), neck circumference, waist circumference, oxyhemoglobin desaturation, apnea-hypopnea index and blood pressure:The results showed that the levels of ADM in peripherial blood were significantly positively correlated with neck circumference, waist circumference and apnea-hypopnea index (r=0.179,P=0.004; r=0.180, P=0.004; r=0.151, P=0.015), however, there were no markedly correlation between ADM and body mass index and blood pressure; (4) Correlation of AHI with body mass index (BMI), neck circumference, waist circumference, oxyhemoglobin desaturation and blood pressure:The results showed that AHI were significantly positively related with body mass index (BMI), neck circumference, waist circumference (r=0.356, P=0.000; r=0.232, P=0.000; r=0.318, P=0.000) and negatively related with oxyhemoglobin desaturation and lowest oxyhemoglobin desaturation (r=-0.499, P=0.000; r=-0.683, P=0.000), but not markedly related with blood pressure; (5) Aassociation of ADM and oxyhemoglobin desaturation: To investigate the association of ADM and oxyhemoglobin desaturation, the oxyhemog-lobin desaturation were quartiled and the cutoff value were 91%,93% and 94%, further-more, analyzed the ADM level among the different quartiles, the value was expressed with Mean±SD, the ADM of-91% group was 92.23±19.41,78.24±20.18 in 91-93% group. 67.71±17.54 in 93-94% group and 64.19±15.48 in 94%-group respectively. The ADM of 93-94% group and 94%-group were significantly lower compared with-91% group and 91-93% group (P=0.000), however, there was no difference of ADM between 93-94% group and 94%-group (P=0.268). The logistic analysis results showed that oxyhemoglobin desaturation was independently associated with ADM (P=0.038), under the control of age, sex, BMI, neck circumference, waist circumference and blood pressure. Conclusion:(1) The OSAHS had more significantly effective on the ADM than Hypertension; (2) It was no certainly that the effects of ADM on OSAHS complicated with hypertension, since the results of factorial design showed that the hypertension has no effect on ADM and there was no difference of ADM between OSAHS without hypertension and OSAHS complicated with hypertension patients.