The Changes Of Blood Pressure And Plasma 5-HT Of Obstructive Sleep Apnea Hypopnea Syndrome Patients

Obstructive sleep apnea hypopnea syndrome(OSAHS) is adisease with high incidence,and it has become a research hotspot inall the field in medicine。The objective of this study is to observe thechanges of the blood pressure and plasma 5-hytroxytryptamine(5-HT) in obstructive sleep apnea hypopnea syndrome(OSAHS) patients. Part I:Method:The detection of whole-night polysomnography isperformed in 73 OSAHS patients including the outpatients and theinpatients of the first hospital,Jilin University, the measurement ofblood pressure before and after sleep is done simultaneity. Beforesleep the height,the weight,the neck circumference and the bodymass index are also be measured. Make clear and register thehistory of hypertension and the effect of pharmacologic treatment inOSAHS patients with hypertension. Divide the patients into 3groups(mild,moderate ,severe) according to the result of PSGexamination compared with the OSAHS diagnose standardconstituted by the Chinese medical association. Analyzed the datastatistically.Result:There are 76.923% of patients with hypertension inmild OSAHS group,71.428% of patients in moderate OSAHSgroup and 84.783% in wild OSAHS group. There are 60 OSAHSpatients with hypertension while 47 patients with hypertensionhistory. In the 47 cases,pharmacologic therapy has processed in 40cases,but satisfied effect can be seen in only 13 cases(32.5%).Pharmacologic therapy alone does not work on the increased bloodpressure in most of the OSAHS cases with hypertension(67.5%).No difference is found between the blood pressure before and aftersleep in mild OSAHS group(P>0.05),in moderate and severeOSAHS group the blood pressure after sleep is significantly higherthan it before sleep(P<0.05). The elevation of blood pressureincreases with AHI,the neck circumference and BMI.Discussion:Many epidemiology research suggests that the morbidity ofhypertension in OSAHS patients is higher than it in normalsubjects,and the result of our study is accordant. It is proved in ourstudy that it has a close relationship between OSAHS andhypertension,and OSAHS is a risk factor of hypertension. There isno difference between the blood pressure before and after sleep inthe mild OSAHS group,while the blood pressure after sleep issignificant higher than it before sleep(P<0.05),which indicate thatthe severity of OSAHS and the hypoxemia may involve in theoccurring of hypertension in OSAHS patients. It is also observedthat the elevation of blood pressure increases with AHI,the neckcircumference and BMI,which reflect the degree of obesity. Manyfactors involve in the hypertension in OSAHS patients,includingthe increased activity of sympathetic nerve system caused byhypoxemia and hypercapnia , sleep fragment , the damage inendothelium,the abnormity in vessel and body fluid,the abnormityin chemical and pressure reflection,obesity and descendiblity,et al.Pharmacologic therapy alone does not work on the increased bloodpressure in most of the OSAHS cases with hypertension(67.5%). Itis indicated that many pathophysiological changes are involved inthe etiopathogenisis and the development of hypertension inOSAHS patients. It is proved that long-term n-CPAP therapy isnecessary,and it is the most effective treatment. In the diagnosis ofhypertension,especially for the intractable hypertension,OSAHSmay be the etiopathogenisis or the accompanied disease. We shouldthink highly of the existence of the hypertension in OSAHS patient.For these patients,especially for the patients with obesity andsnoring,the PSG examination should be done in time. N-CPAPtherapy should be preformed in the hypertension patients withOSAHS,it can adjust the sleep disorder,amend the hypoxemia. It isimportant to control the blood pressure in hypertension patients withOSAHS.Part II:Methods:5-HT concentrations in the plasma from 10 normal cases and73 cases of OSAHS who diagnose by PSG examination aredetermined by radioimmunoassay. Analyzed the data statistically.Results:5-HT concentrations in the mild, moderate and severe OSAHSpatients increased significally compare with normal adults(P<0.05).There were significant differences among mild, moderate and severeOSAHS groups(P<0.05).Discussion:5-HT concentrations in the OSAHS patients increasedsignifically compare with normal adults. The elevation degree of5-HT concentration in OSAHS patient correlate with the severity ofOSAHS. The plastocyte activation and the increased 5-HT releasewhich caused by the raised sympathetic activity may be thereasons. 5-HT in plasma promotes the development of OSAHS bywide-distributed 5-HT receptor. It forms a vicious circle,resulting inincreasing the 5-HT concentration to a high level and aggravatingthe OSAHS ceaselessly. Because plasma 5-HT concentrationcorrelate with the severity of OSAHS,it can be used to be aassistant target to evaluate the state of OSAHS.