| BackgroundArteriosclerosis and pulse pressure increase is considered to be the most common diseases of cardiovascular system, almost people think that is a normal performance of organism aging, which needs none treatment. In recent years,a large number of studies have found that arterial stiffness is an independent predictor of cardiovascular disease and death, the correlation of arteriosclerosis and hypertension is well known. Atherosclerosis is the most important and most common type in the hardening of the arteries, also is the most common disease of cardiovascular system diseases.in recent years, many studies have shown that in the early stage of atherosclerosis, the arterial vascular wall has changed in function or structure.that is to say, by detect the dysfunction of the arterial vascular wall, we can prevent the further development of atherosclerosis, also can provide a new measure for cardiovascular clinical risk stratification, it has important significance for the prevention and treatment of atherosclerosis disease especially for the cardiovascular and cerebrovascular diseases.Which not only helps us to understand vascular characteristics of patients with cardiovascular and cerebrovascular, to guide clinical treatment and prognosis, but also can filtrate the patients who have higher risk of cardiovascular disease from the "normal people".Based on the understanding, in recent years,the study of artery structure and function springing up vigorously, a variety of methods, indicators and instruments to detect the degree of atherosclerosis.At present, the widely accepted index reflecting artery elastic function testing mainly includes:the arterial pulse wave conduction velocity (pulse wave velocity, PWV) and the reflected wave of pulse wave form analysis augmentation index (augmentation index, AI). But, these inspection index need expensive equipment and trained operators,so they are restricted in the large-scale popularization and application in clinical practice and epidemiological study. Therefore, the development of more simple and effective detection technology has very realistic significance. In 2006 the American journal of hypertension published two articles, the paper introduces a data by using the conventional 24 h ambulatory blood pressure monitoring,by which can calculate the index to reflect the degree of arteriosclerosis, which is called "dynamic arteriosclerosis index" (ambulatory arterial stiffness index, AASI). The new index needs no specialized test equipment, immediately brought to the attention of the academia, triggered a heated discussion.The compliance of the artery depends on the artery volume and wall flexibility and expansibility. In normal circumstances,the fluctate of mean arterial pressure is consistent with the fluctate of systolic and diastolic blood pressure; As the compliance of the artery falling, the falling range of diastolic pressure is smaller than the falling range of systolic blood pressure; When the arterial compliance was badly damaged, it is shown as the increase of systolic blood pressure, and the falling of diastolic blood pressure, the mean arterial pressure usually increases with day activity, decrease when sleep at night, it shows that to some extent,the changes of the relationship between systolic and diastolic blood pressure can reflect the elasticity of the arterial function. AASI is an index which is based on the above principle,by using 24 hours ambulatory blood pressure testing, get a series of systolic and diastolic blood pressure values, and then,work out the regression coefficient of the relationship between the changing in systolic blood pressure and diastolic blood pressure,then use 1 minus the regression coefficient can get the arterial stiffness index (AASI), when the AASI is closer to 1, the more serious arteriosclerosis is.Obstructive Sleep Apnea hypopnea Syndrom (OSAHS) is a syndrom which assumes snoring and apnea at night, frequent awakening and sleep fragmentation during sleep,which is caused by the upper airway is frequently complete or partial collapse.The clinical syndrom is the excessive daytime sleepiness, change of cognitive function decline, endocrine metabolism, lower quality of life and personality changes.Polysomnography,(P S G) is the gold standard in the diagnosis of this disease, and the quantitative indicators is apnea hypoventilation index (AHI).In a seven-hours long sleep in the night, every time the nose or mouth air suspended for more than 10 S, apnea recurrent above 30 times, or AHI is greater than 5 times per hour,according to that,we can diagnosis as OSAHS. The cause of OSAHS may include the following several mechanisms such as:(1) the change of autonomic nervous function; (2) hypoxia-again the cycle of oxygenation process; (3) the inflammatory response, therefore, OSAHS is not just a disease exist in the local, it should be regarded as a systemic disease.In recent years, the study found that the patients with OSAHS recurring hypoxemia, hypercapnia, and micro structure of sleep disorders and wakefulness in the night,that may plays an important role in the development of atherosclerosis.Its mechanism seems to be:(1) material shrinks blood vessels and adhesion molecule expression; (2) the sympathetic nervous system activity increases; (3) insulin resistance; (4) metabolic disorders; (5)oxidative stress; (6) inflammatory reaction and a series of pathophysiological process.It show that OSAHS may leading to the development of the cardiovascular and cerebrovascular diseases by participating in the exacerbation of atherosclerosis.Several earlier studies found the fluctuate of systemic blood pressure associated with OSAHS by using arterial catheter, however, until recently the exact data confirmed the hypothesis that the OSAHS can cause chronic hypertension and other cardioascular disease (CD).Numerous studies have shown that OSAHS is an independent risk factors for hypertension, it also aggravate the cardiovascular and cerebrovascular diseases and lead to one of the reasons for the increased mortality.Epidemiological data showed that OSAHS is associated with hypertension, which is reported abroad that 45%-48% of the patients with OSAHS have hypertension. Domestic research also showed that the incidence of OSAHS patients with hypertension was 49.3%, the general population was 23.5%. More than 30.0% of the hypertensive patients with OSAHS, and to this part of patients,it is easy to misdiagnosis and delay treatment of OSAHS. There are lots of study at home and abroad for patients with hypertension combined OSAHS,but for these patients, could AHI affect AASI and the degree of influence has no relevant literature reports.ObjectivesChoose the patients who has hypertension combined with OSAHS as the research object, setting these patients as the control group, using the modern advanced detection technology, explore the relationship of AASI and AHI in these patients. That was designed to examine whether the degree of arteriosclerosis in patients who have hypertension combined with OSAHS is more serious than the patients with hypertension,and the relevance with the severity of OSAHS.MethodsCollect 153 cases of patients from the south hospital cardiovascular internal medicine who were hospitalized between September 2013 and February 2015, and treated with sleep monitoring, among which 126 were male,27 were female, who aged from 27-82 (42.34±12.45)year. Implement 24 hours ambulatory blood pressure monitoring and polysomnography, all patients were in accordance with the WHO diagnostic criteria of hypertension, which means systolic blood pressure higher than 140mmHg and/or diastolic blood pressure higher than 90mmHg, among them,79 cases were diagnosed as OSAHS according with the guidelines of Chinese medical association respiratory neurology, sleep respiratory disease committee which developed in 2002,that means in a seven-hours long sleep in the night, every time the nose or mouth air suspended for more than 10s, apnea recurrent above 30 times, or AHI is greater than 5 times per hour can be diagnosed as OSAHS. Exclusion criteria: ①acute coronary syndrome (ACS)② severe heart failure in heart function (class Ⅲ-Ⅳ)③cardiomyopathy ④ serious liver and kidney dysfunction ⑤ cor pulmonale,COPD ⑥ renalparenchymal-hypertension,renovascular-hypertension,primary-hyperaldosteroni sm, pheochromocytoma and so on.According to the result of PSG,153 cases of hypertension patients were divided into experimental group (OSAHS group,79 cases) and control group (non-OSAHS group,74 cases).All selected objects are record the general data in detail, include:age, gender, height, weight, etc.all patients drawn blood in the fasting state, using automatic biochemistry analyzer monitor fasting blood glucose, blood lipid, etc.24 hours ambulatory blood pressure monitoring:use the 24 hours ambulatory blood pressure detector to measure brachial artery blood pressure which is developed by the SUNTECH company from USA. all patients discontinued asoactie drugs more than 3 days, in the daytime,BP measured from 8:00 to 22:00, measured once every 20 minutes, in the night,BP measured from 22:00 to 8:00, measuring every 30 minutes, to get the SBP and DBP at different times, calculate the linear regression relationship between SBP and DBP, in this equation, DBP=a+bSBP, SBP as independent variables, DBP as dependent variable, the calculation method of AASI is 1 minus the regression coefficient differential value of b.Polysomnography (PSG):all patients using polysomnography system (American SADMAN) conduct all night PSG(>7 h) in the sleep center of our hospital, all patients forbidden with sedative drugs and alcohol, coffee, strong tea, such as stimulant drinks from72h before, get apnea hypoventilation index (AHI), AHI refers to the time of sleep apnea and low ventilation per hour, according to the guidelines of diagnosis and treatment of OSAHS, AHI average more than 30 times or more than 5 times per hour can be diagnosed as OSAHS.All analysis was performed with the use of SPSS software version 16.0. The measurement data were expressed as mean±standard deviation, two independent t test was applied to analyze the difference between case group and control group, Pearson correlation test was used to analyze the correlation of bivariate, When P< 0.05, the difference has statistics significance.Results1.Experimental group compared with control group in baseline characterastic: the age, gender, BMI,24hSBP,24hDBP,24hPP,24hHR in these two groups have no statistically significant difference, in terms of incidence of coronary heart disease, hyperlipidemia, the experimental group was higher than the control group, but there was no statistically significant difference (p>0.05).2.AASI value comparison in experimental group and control group:the experimental group (0.599+0.118) is higher than that of control group (0.381+ 0.098), the difference was statistically significant (p<0.05).3.Correlation analysis in AASI and AHI:AASI is positively correlated with AHI in the experimental group (r=0.617, p<0.01).Conclusions1.The degree of atherosclerosis in patients with hypertension and OSAHS is higher than non-OSAHS hypertension patients, this indicates that OSAHS can aggravate atherosclerosis.2.The value of AASI and AHI is positively correlated in positively correlated. |
PDF Full Text Request