Distribution Laws Of Chinese Medical Syndromes And Analyses Of Relative Factors In Hypertension Patients With Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSAS) is highly relevant to patients with hypertension, which is the independent risk factor for hypertension. The precise mechanisms of OSAS-related hypertension have not yet been elucidated but are almost certainly of multiple origins. Potential mechanisms include sympathetic over activity secondary to recurrent hypoxias and arousals from sleep, endothelial dysfunction, increased coagulation and metabolic dysregulation. There is proof of Chinese Medicine (CM) which has been shown to relieve hypertension and improve related symptoms. This study summarized the distributive features of CM syndrome of Hypertensive patients combined with OSAS and analyze the relationship between the main syndrome elements of OSAS-related hypertension and indexes, such as Apnea Hypopnea Index (AHI), Body Mass Index (BMI), High Sensitive C-reactive Protein (hs-CRP), in order to providing basis for further theoretical and clinical research.This study is divided into two parts:literature review and clinical research.1. Literature reviews:including the following two parts.Review 1:Summarized the distributive features of CM syndrome of OSAS and OSAS-related hypertension which various scholars have explored recently.Review 2:Correlation between OSAS-related hypertension and hs-CRP:a systematic review.Objective:To assess the correlation between hs-CRP and OSAS-related hypertension.Methods:The case-control studies involving hs-CRP in OSAS-related hypertension (case group) were searched from PubMed, Cochrane Library, China Academic Journals Full-text database, VIP Database, Chinese Biomedical Literature CD-ROM databases and full text database of China’s important meetings, and relevant periodicals were also searched manually. Two reviewers independently collected the data, assessed the quality, and conducted the Meta-analysis by using Revman 5.3.5.Results:Among total 15 studies involving 2739 participants were included. Results of Meta-analyses showed that:a) The hs-CRP level in OSAS-related hypertension was significantly higher than OSAS without hypertension and hypertension without OS AS;b) the level of hs-CRP in OSAS-related hypertension was correlated with the different grades of OSAS.Conclusion:The level of hs-CRP is significantly increased in OSAS-related hypertension patients. Detecting hs-CRP can to some extent reflect the severity of OSAS.2.Clinical research:Distribution laws of CM syndrome types and analyses of relative factors in hypertension with OSAS.Objective:To study the distributive features of TCM syndrome of Hypertensive patients with OSAS; to analyze the relationship between the main syndrome elements of hypertension with OSAS and indexes, such as Apnea Hypopnea Index (AHI), Body Mass Index (BMI), Target Organ Damage (TOD), Blood Pressure Variability (BPV), blood lipid level, Homocysteine, High Sensitive C-reactive Protein (hs-CRP).Methods:A total of 195 hypertensive patients were collected, including 121 patients with OSAS,71 patients without OSAS. The information of each patient was perceived by the questionnaire. Focus on CM syndrome of hypertension with OSAS patients and summarize the common syndromes. The data of patients such as 24 hours automatic blood pressure parameters, ultrasonic cardiogram, carotid ultrasound, sleep monitoring items and biochemical indexes are collected and analyzed by SPSS21.0 statistical package for data processing, normal data were analyzed by t test, non-normal data were analyzed by rank sum test, for comparison between multiple sample analysis of variance, P<0.05 considered significant difference.Results:1. The average BMI and waist level of hypertension with OSAS group were higher than the hypertensive without OSAS group (P<0.05). Patients with OSAS-related hypertension had a higher level of hs-CRP than those of hypertension without OSAS (P<0.05). The rate of renal damage, left ventricular hypertrophy (LVH), non-dipper type hypertension with OSAS-related hypertension were significantly higher than that in hypertensive subjects without OSAS (P<0.05). Compared with the hypertensive without OSAS group, the patients with OSAS-related hypertension had higher mean values of HDL-C (P<0.05).2. Syndrome distribution of hypertension with OSAS2.1 Investigated 124 patients of hypertensive with OSAS, the results showed that: phlegm wet takes up 31.5%, excessive blood stasis takes up 22.6%, yin deficiency and yang hyperactivity takes up 19.4%, liver-fire hyperactivity takes up 10.5%, kidney yin deficiency takes up 8.1%, kidney yang deficiency takes up 8.1%. Phlegm wet, blood stasis and yin deficiency are the common syndrome of hypertension with OSAS.2.2 64 patients syndrome of phlegm wet accumulated points achieve threshold value;41 patients syndrome of blood stasis accumulated points achieve threshold value; 30 patients syndrome of yin deficiency accumulated points achieve threshold value; 21 patients syndrome of yang hyperactivity accumulated points achieve threshold value; 13 patients syndrome of liver-fire accumulated points achieve threshold value; 10 patients syndrome of yang deficiency accumulated points achieve threshold value. Phlegm wet and blood stasis are common syndrome elements of hypertension with OSAS.2.3 The collection of symptoms and signs showed the most common clinical symptoms of hypertension with OSAS:vertigo (82.3%), chest distress (72.6%), dizzy (54%). The occurrence of tongue and pulse:fat tongue (44.4%), purple tongue (37%), slippery pulse (50.8%).3. There is a significant statistical difference in the gender of syndrome patterns. Prevalence rate of males is higher in liver-fire and phlegm wet, while that rate of females is higher in yin deficiency and yang deficiency. The average age of liver-fire and yang hyperactivity are lower than subgroups of other syndrome patterns (P<0.05), while the average age of yang deficiency is higher than that of other subgroups (P<0.05).4. In hypertensive patients with OSAS, the detection rate of carotid atherosclerosis is higher in the phlegm wet group (P<0.05); the level of TG is significantly higher in the blood stasis group (P<0.05).Conclusion:1. The level of BMI, waist, HDL-C, hs-CRP and the rate of target organ damage and non-dipper hypertension might be important factors of hypertension with OSAS.2. Phlegm wet and blood stasis are common syndrome of hypertension with OSAS patients. The primary syndrome patterns of hypertension with OSAS are phlegm wet and blood stasis.3. The average age of liver-fire and yang hyperactivity is less than other syndrome patterns, while that of yang deficiency is much higher.4. The occurrence of carotid atherosclerosis, to some extent, has a reference meaning for phlegm wet syndrome. The level of TG, to some extent, has a reference meaning for blood stasis syndrome.