Application Value Of Rapid Eye Movement Sleep Period Parameters In Predicting Hypertension In Patients With Obstructive Sleep Apnea Hypopnea Syndrome

BackgroundObstructive sleep apnea hypopnea syndrome（OSAHS）is closely related to the hypertension.The rapid eye movement（REM）sleep period shows a greater influence on blood pressure than the non-rapid eye movement（NREM）sleep period caused by the physiological structure.However,the correlation between REM sleep breathing event and hypertension in OSAHS patients is still unclear.This study intends to evaluate the effect of polysomnography（PSG）parameters,including REM paremeters and NREM paremeters,on the 24-hour ambulatory blood pressure of the OSAHS patients.Objective1.Exploring the clinical characteristics of OSAHS patients with hypertension.2.Screening the risk factors of hypertension in OSAHS patients.3.Evaluating the diagnostic value of the REM sleep parameters in predicting hypertension in OSAHS patients.MethodsOSAHS patients were recruited and underwent PSG and 24-hour ambulatory blood pressure monitoring（ABPM）in sleep center of the First Affiliated Hospital of Guangzhou Medical University from May 1,2017 to November 30,2020.According to the diagnostic hypertension criteria,the patients were divided into two groups,the hypertension group and the normal blood pressure group.The clinical characteristic data,including demographic characteristic,laboratory test,PSG and ABPM,were collected and analyzed the differences of the two groups from the patients.The multiple linear regression was used to analyze the effect factors of blood pressure in OSAHS patients.The risk factors of hypertension in OSAHS patients were screened by the univariate and multivariate logistic regression.The ROC curve was used to evaluate the diagnostic value of REM sleep parameters in predicting hypertension in OSAHS patients.Results1.Among 114 OSAHS patients were enrolled in this study,with 63.16%（72cases）of the patients complicated with hypertension,16.67%（19 cases）of the patients complicated with isolated nocturnal hypertension（INH）and 45.62%（52cases）of the patients complicated with non-isolated nocturnal hypertension（NINH）.2.The prevalence of hypertension gradually increased with severity of OSAHS.The prevalence of complication with hypertension a mong the patient s with mild,moderate and severe OSAHS were 6.67%,30.76%and 71.54%,respecti vely,and there were significant difference（X²=29.205,P<0.001）.3.The difference of clinical characteristics of patients in the hypertension group and the normal blood pressure group were showed as follow:（1）in terms of demographic characteristic,the body mass index（BMI）,neck circumference and waist circumference of the hypertension group were significantly higher than those in the normal blood pressure group（P<0.05）.（2）in terms of laboratory test,the hemoglobin A1c（Hb A1c）and serum creatinine（Scr）of the hypertension group were higher than those in the normal blood pressure group（P<0.05）.（3）in terms of PSG parameters,microarousal index（MAI）,apnea hypopnea index（AHI）,rapid eye movement sleep period apnea hypopnea index（REM-AHI）,non-rapid eye movement sleep period apnea hypopnea index（NREM-AHI）,the proportion of time that arterial blood oxygen saturation below 90%in total sleeping period（T90%）,the proportion of time that arterial blood oxygen saturation below 90%during rapid eye movement sleep period（REM-T90%）and the proportion of time thatarterial blood oxygen saturation below 90%during non-rapid eye movement sleep period（NREM-T90%）of the hypertension group were higher than those in the normal blood pressure group（P<0.05）.The mean pulse oxygen saturation（MSp O₂）,rapid eye movement sleep period mean pulse oxygen saturation（REM-MSp O₂）,non-rapid eye movement sleep period mean pulse oxygen saturation（NREM-MSp O₂）and lowest arterial oxygen saturation（LSa O₂）of the hypertension group were lower than those in the normal blood pressure group（P<0.05）.The percentage of N3 sleep in total sleep time（N3%）of the hypertension group was lower than that in the normal blood pressure group（P<0.05）.4.The correlation analysis indicated that 24 hour average systolic blood pressure（24h SBP）,24 hour average diastolic blood pressure（24h DBP）,daytime average systolic blood pressure（d SBP）,daytime average diastolic blood pressure（d DBP）,nighttime average systolic blood pressure（n SBP）and nighttime average diastolic blood pressure（n DBP）were positively correlated with BMI,neck circumference,waist circumference,REM-AHI,NREM-AHI,REM-T90%and NREM-T90%,and negatively correlated with REM-MSp O₂,NREM-MSp O₂and LSa O₂（P<0.05）.The correlation coefficients of REM-AHI and 24h SBP,24h SBP,d SBP,d SBP,n SBP,n SBP were 0.456,0.467,0.435,0.467,0.458,0.433,respectively（P<0.001）.Multiple linear regression analysis found that 24h SBP,d SBP,d SBP and n SBP were independently correlated with REM-AHI and neck circumference,and n DBP was independently correlated with REM-AHI.5.The univariate logistics analysis found that 11 parameters including BMI,neck circumference,waist circumference,REM-AHI,NREM-AHI,MAI,REM-MSp O₂,NREM-MSp O₂,LSa O₂,REM-T90%and NREM-T90%were the risk factors for hypertension in OSAHS population,the OR values were 1.180（95%CI,1.046-1.330）,1.174（95%CI,1.039-1.327）,1.094（95%CI,1.040-1.150）,1.046（95%CI）,1.025-1.067),1.042（95%CI,1.024-1.062）,1.033（95%CI,1.009-1.057）,0.862（95%CI,0.791-0.940）,0.786（95%CI,0.675-0.915）,0.925（95%CI,0.889-0.962）,1.036（95%CI,1.018-1.054）and 1.048（95%CI,1.022-1.075）,respectively（P<0.05）.Multivariate logistics analysis only found that the REM-AHI was an independent risk factor for hypertension in the OSAHS population,with OR value of 1.032（95%CI,1.010-1.056）（P<0.05）.6.The ROC curve analysis found that the AUC of REM-AHI in the diagnosis of hypertension in OSAHS was 0.778[（95%CI,0.690-0.866）,P<0.001],the maximum Youden index was 0.533,and the optimal cut-off value was 47.45 times/h,the sensitivity was 78.9%,and the specificity was 74.4%.Conclusions1.The complication of hypertension is common in OSAHS.The risk of hypertension increases with the severity of OSAHS;2.The clinical characteristics of hypertension with OSAHS patients are obesity,frequent respiratory events,low blood oxygen saturation and reduced deep sleep time;3.REM-AHI is an independent risk factor of hypertension in OSAHS patients.When the REM-AHI increases 1 per hour,the risk of hypertension increases 3.2%in OSAHS patients;4.REM-AHI>47.45 per hour is the optimal cut-off value in OSAHS patients for prediection hypertension.