Effect Of Obstructive Sleep Apnea Hypopnea Syndrome On Blood Pressure And Blood Glucose In Patients With Hypertension

ObjectiveObstructive sleep apnea syndrome(OSAHS) is a disorder characterized by repeated collapsed and obstruction of the upper airway during sleep,which often accompanied by snoring, frequent occurrence of oxygen desaturation, daytime sleepiness, difficulty concentrating, and can lead to diabetes, hypertension, coronary heart disease and other multi-system damage. OSAHS is a relatively common complication more sleep breathing disorders. More and more studies have discovered and confirmed that OSAHS is an independent risk factor for hypertension and is closely associated with abnormal glucose metabolism. American Evaluation Commission for the Control of hypertension and seventh report has explicitly OSAHS as one major cause of secondary hypertension, and pointed out that Systolic blood pressure( SBP) is more important than diastolic blood pressure of cardiovascular disease risk factors. Different blood pressure parameters for target organ damage is different, OSAHS and hypertension coexist, will increase glucose metabolism, and promote the development of atherosclerosis, increased target organ damage. This study observed the differences of blood pressure, blood sugar between hypertension patients with OSAHS and patients with hypertension and the changing mechanisms of blood pressure, blood glucose in OSAHS patients with hypertension before and after the treatment. The fully understand to OSAHS and its multi-system damage, early treatment of OSAHS is significant to prevent complications.MethodsThe study set hypertension group as the control group, hypertension with OSAHS group as observation group and contrast experiments. Select 216 hypertensive patients in February 2012- March 2014 in our hospital, 62 patients(male 45, female 17) who were 32-70(average 43.8±9.3) years old with OSAHS diagnosed by sleep monitoring were enrolled in this study as observation group. These patient’s BMI is 26.4±3.2. 154 patients(male 108, female 46) who were 29-68(average41.6±9.0) years old without OSAHS were enrolled in this study as control group. These patient’s BMI is 28.8±2.8. Another 62 cases of hypertension patients with OSAHS werecompared before and after non-invasive positive pressure ventilation. After the same treatment for all patients to take antihypertensive drug nifedipine 20 mg 2 times / day, fosinopril sodium tablets 10 mg 2 times / day, blood pressure in morning 10:00, calculate mean arterial pressure, pulse pressure, fasting glucose, Fasting insulin(FINS),2 hours glucose after breakfast,2h INS were detected before treatment and 12 week later, then compare the different groups changes in blood pressure, blood sugar metabolism. The same Indicators were detected after noninvasive positive pressure ventilation treatment to 62 hypertension patients with OSAHS. The changes in blood pressure, blood sugar metabolism AHI, LSp O2, the longest apnea time were compared. Statistical analysis by SPSS 17.0 was used, p<0.05 was considered statistically significant.Result1. The basis of control group and observation group: The difference of age, sex and BMI between the two groups had no statistically significance(t=-11.28, P>0.05).2. Comparative analysis of measurements between the two groups2.1 Blood pressure in morning 10:00, in observation group :SBP 160.7±15.4mmHg, DBP 95.4±5.8mm Hg,Mean arterial pressure 113.5±9.4mm Hg; in control group SBP140.6±10.6mm Hg, DBP 90.2±4.3mm Hg, Mean arterial pressure96.6±10.2mm Hg, two groups had statistically significance, P<0.05. in observation group:PP 40.2±10.2 mm Hg,in control group PP42.4±9.8mm Hg,P>0.05, two groups had no statistically significance。2.2 Blood glucose, FPG(fasting glucose)in observation group(mmol/L)7.81±3.05, in control group 6.18±2.84, t=3.581; 2h PG(2 hours glucose after breakfast)(mmol/L)in observation group 15.66±1.72, in control group 12.40±1.50, t=6.825, FINS(mμ/L)in observation group 17.2±5.9,in control group 26.1±7.4,t=6.46;2h INS(mμ/L)in observation group 29.6±11.3,in control group 78.5±12.2,t=22.18, two groups had statistically significance, P<0.01.2.3 Comparison of blood pressure and blood sugar levels in hypertensive patients with various degree of OSAHS2.3.1 Blood pressure in morning10:00 :With mild OSAHS groupSBP148.5±12.7mm Hg,DBP 88.9±11.6mm Hg;With moderate OSAHS group:SBP158.4±15.6mm Hg,DBP 98.6±16.8mm Hg;With severe OSAHS group:SBP175.2±22.4mm Hg,DBP110.2±21.8mm Hg;two groups had statistically significance, P<0.01.2.3.2 Blood glucose, With mild OSAHS group:FPG(mmol/L)5. 1±0.8,2h PG(mmol/L)7.9±1.1;With moderate OSAHS group:FPG(mmol/L)7. 1±0.9,2h PG(mmol/L)10.6±1.7;With severe OSAHS group:FPG(mmol/L)9.2±1.5,2h PG(mmol/L)14.5±2.3;2.4 The same Indicators were detected after noninvasive positive pressure ventilation treatment to the observation group and compared.2.4.1 Blood pressure in morning 10:00 before treatment: SBP 160.7±15.4mm Hg, DBP 95.4±5.8mm Hg, Mean arterial pressure 113.5±9.4mm Hg, Blood pressure in morning 10:00 after treatment: SBP 138.2±12.2mm Hg, DBP 89.6±7.4mm Hg, Mean arterial pressure 102.1±8.6mm Hg, The difference had statistically significance(P<0.05).before treatment PP 40.2±10.2 mmHg,after treatment PP 42.5±9.2,P>0.05,The difference had no statistically significance。2.4.2 Blood glucose: FPG before treatment(mmol/L)7.81±3.05, after treatment 5.30±2.10, t=3.450; 2h PG before treatment(mmol/L)15.66±1.72, after treatment 59.40±1.50, t=6.960, FINS( mμ/L) before treatment 17.2±5.9, after treatment 14.1±4.9,2 h INS(mμ/L)before treatment 29.6±11.3,after treatment 76.5±11.2, The difference had statistically significance P <0.01.2.4.3The changes of sleep apnea-hypopnea index(AHI), LSp O2, the longest apnea time before and after treatment:after 12 weeks treatment,AHI and the longest apnea time were lower than before treatment, LSp O2 was higher than before treatment(P < 0.05)ConclusionSleep breathing disorders is related with blood pressure and abnormal glucose metabolism. In OSAHS group, it is difficult to return to normal levels by only antihypertensive drugs. Blood pressure, abnormal glucose metabolism increased significantly in this group. After treatment for OSAHS, Systolic blood pressure, diastolic blood pressure, blood sugar can be effectively controlled.