Analysis Of Clinical Characteristics And Therapeutic Effect Of Patients With Positional Obstructive Sleep Apnea Syndrome In Patients With Hypertension

Objective To analyze the clinical characteristics of patients with positional obstructive sleep apnea syndrome（POSA）in hypertensive population and the effect of postural treatment.MethodsThe hypertensive patients who were hospitalized in the Hypertension Center of the People’s Hospital of Xinjiang Uygur Autonomous Region from December 2018 to December 2020 with AHI≥5 times/h were included.According to the inclusion and exclusion criteria,561 patients with OSAS were collected,including position-related obstructive There were 207 sleep apnea patients（POSA group）and 354non-position-related obstructive sleep apnea patients（NPOSA group）.The clinical characteristics of POSA and NPOSA patients were observed.In order to further observe the effect of the"tennis back pad method"on the treatment of POSA,continue to include 60 patients（25 cases of mild,25 cases of moderate,and 10 cases of severe）who agreed and successfully completed the posture treatment and the sleep breathing test.Observe the posture Changes in sleep parameters and blood pressure before and after treatment.Results1.The percentage of POSA patients in this study was 37%.The age of the 207 Candle 561,POSA group was older than that of the NPOSA group,and the neck circumference,body weight,BMI and morning diastolic blood pressure were significantly lower than those of the NPOSA group（P<0.05）.The average levels of systolic blood pressure and diastolic blood pressure in POSA group were lower than those in NPOSA group,（P>0.05）.PSG parameters:AHI,left lateral AHI,right lateral AHI and mean oxygen saturation（MSaO2）in POSA group were lower than those in NPOSA group,sleep efficiency and duration of stage N1 and N3 were lower than those of NPOSA,supine AHI,N2 and N4 in supine position were higher than those in NPOSA group.Multivariate Logistic regression analysis showed that age≥65 years old and AHI≤30 times/h were risk factors for POSA（OR=1.959,95%CI 1.055-3.636,P=0.030;OR=0.310,95%CI 0.198-0.485,P<0.001）.2.Supine sleep time[80.8min（40.4,118.0）vs.149.1min（87.7,228.1）],sleep apnea hypopnea index（AHI）[10.9（6.7,17.1）vs.17.0（10.2,24.2）],supine AHI[（30.5±22.3）vs.（41.0±23.7）],blood oxygen saturation（SaO₂）<TST 90%（TST90）[11.9（4.4,31.0）vs.23.0（4.9,78.7）],Morning diastolic blood pressure[（87.9±10.1）mm Hg vs（91.9±11.4）mm Hg]were significantly decreased after postural treatment,and the mean SaO₂（93%vs.92%）,the lowest SaO₂（83%vs.81%）were significantly increased（P<0.05）.Morning systolic blood pressure decreased[（139.6±12.6）mm Hg vs.（142.6±15.3）mm Hg],but the difference was not statistically significant（P>0.05）.It was further found that the AHI and TST elevation of POSA patients in the mild and moderately severe groups were significantly reduced after treatment（P<0.05）,and the AHI and morning diastolic blood pressure were significantly reduced in patients with moderate to severe OSA after treatment（P<0.05）,but The mild OSA group did not change significantly before and after treatment（P>0.05）;after posture treatment in obese and non-obese POSA patients,TST elevation and AHI decreased,TST_left,TST_right,and MSaO₂ increased（P<0.05）,and obese POSA patients After treatment,diastolic blood pressure was significantly reduced in the morning（P<0.05）;TST elevat ion,AHI elevation,AHI,and TST 90 were significantly reduced after treatment in POSA patients aged<50 years and age≥50 years;TST_left,TST_right,and MSaO₂ increased（P<0.05）,and the diastolic blood pressure of POSA patients aged≥50 years was significantly reduced in the morning after treatment（P<0.05）.Correlation analysis showed that△TST_supine was positively correlated with△AHI and（r=0.371,P=0.007）,and negatively correlated with△AHI_supine（r=-0.404,P=0.003）;and△MSaO₂ was positively correlated with△TST_right（r=0.283,P=0.038）.Multiple linear regression analysis showed that gender and△TST_supine were independent influencing factors of AHI changes before and after postural treatment（P<0.05）.Conclusions1.POSA patients account for 37%of hypertensive patients with OSAS,and their clinical features are that BMI,neck circumference,AHI and morning diastolic blood pressure are significantly lower than those of NPOSA patients;OSAS patients with older age and lower AHI are more likely to show POSA.2.Short-term postural treatment can effectively reduce sleep-disordered breathing events in patients with OSA-related hypertension,improve night hypoxia,and reduce morning diastolic blood pressure.