The Prevalence and Clinical Features of Hypertension in Patients With Obstructive Sleep Apnea Hypopnea Syndrome and Related Nursing Strategies

阻塞性睡眠呼吸暫時低通氣綜合征患者高血壓的患病率、臨床特點及其護理對策

10.1097/jnr.0000000000000111

王彥(Yan Wang)；楊慶嬋(Qing-Chan Yang)；馮靖(Jing Feng)；曹潔(Jie Cao)；陳寶元(Bao-Yuan Chen)

阻塞性睡眠呼吸暫停低通氣綜合征 ； 高血壓 ； 晝夜節律 ； 呼吸暫停低通氣指數 ； 護理 ； obstructive sleep apnea hypopnea syndrome ； hypertension ； circadian variation ； apnea-hypopnea index (AHI) ； nursing

The Journal of Nursing Research

24卷1期（2016 / 03 / 01）

41 - 47

英文

背景：阻塞性睡眠呼吸暫停低通氣綜合征（Obstructive sleep apnea hypopnea syndrome, OSAHS）是常見的睡眠呼吸紊亂疾病。調查顯示OSAHS患者與高血壓相關。目的：調查OSAHS患者中高血壓的患病情況、臨床特點並探討其護理對策。方法：本研究納入3,607例患者，按呼吸暫停低通氣指數（apnea-hypopnea index, AHI）分為對照組354例、實驗組共3,253例，包括輕度組658例、中度組753例、重度組1,842 例。所有患者測量4個時點（日間、睡前、夜間、醒後）血壓值。比較四組高血壓患病率及各個時點血壓值，並計算夜晝平均血壓之比（R_(N/D)）和醒後睡前平均血壓之比（R_(M/E)）。結果：對照組與實驗組（輕度、中度、重度OSAHS）高血壓患病率分別為22.32%，實驗組（輕度、中度、重度OSAHS）各為34.65%、39.04%、55.37%。AHI與高血壓患病顯著相關。4個時點平均血壓隨著AHI升高而升高。R_(N/D) 和R_(M/E)逐漸上升。日間血壓與AHI及最低血氧飽和度顯著相關。AHI ＞ 61－65 後，日間MBP不再隨AHI的增加而升高。結論／實務應用：OSAHS是高血壓的獨立危險因素。OSAHS患者夜間及醒後血壓顯著升高，即失去了正常的血壓晝夜節律。護理人員應針對OSAHS患者高血壓的特點採取必要的護理對策，防止心腦血管意外發生。

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep-related breathing disorder. Hypertension is frequently a concomitant disorder in patients with OSAHS. Purpose: This study investigates the prevalence and clinical features of hypertension in patients with OSAHS and explores the related nursing strategies. Methods: Three thousand six hundred seven patients were included in this study. Subjects were divided into four groups that were categorized according to apnea-hypopnea index (AHI) scores as follows: control group (control, n = 354) with AHI G 5, mild OSAHS (mild, n = 658) with 5 e AHI G 15, moderate OSAHS (moderate, n = 753) with 15 e AHI G 30, and severe OSAHS (severe, n = 1842) with AHI Q 30. Blood pressure (BP) values were measured at four time points (daytime, evening, nighttime, and morning). The prevalence of hypertension and BP values in the different groups were compared at four time points. Finally, the nighttime-to-daytime mean BP (MBP;R_(N/D)) and morning-to-evening MBP (R_(M/E)) ratios were calculated. Results: The prevalence of hypertension in the control group, mild group, moderate group, and severe group were 22.32%, 34.65%, 39.04%, and 55.37%, respectively. AHI positively correlated with the prevalence of hypertension (r = .191, p G .001). The daytime, nighttime, evening, and morning MBP rose as AHI increased. The ratios of nighttime-to-daytime MBP (R_(N/D)) and morning-to-evening MBP (R_(M/E)) increase with the severity of the illness (F = 9.821 and 18.957; p G .001). The daytime BP correlates significantly with AHI and lowest oxygen saturation (LSaO_2; systolic BP, r = .195 and j.206; diastolic BP, rs = .248 and j.251, p G .01). Daytime MBP increases gradually in small fluctuations concurrent with increases in AHI until 61Y65. Conclusions/Implications for Practice: OSAHS is an independent risk factor for hypertension. Patients with OSAHS have a significant increase in nighttime and morning BP, which means they lose normal BP diurnal rhythm. Therefore, nurses should take necessary measures based on the clinical features of hypertension in patients with OSAHS to minimize the risk of cardiocerebral vascular incidents.

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