While the health risks of hypertension are well recognized, the health risks of obstructive sleep apnea hypoventilation syndrome are only just being understood. Obstructive sleep apnea hypoventilation syndrome can not only cause loss of libido, memory loss and mental abnormalities, but also trigger hypertension, diabetes, and in serious cases, coronary heart disease, arrhythmia, cerebrovascular disease, pulmonary heart disease, respiratory failure and other systemic diseases, and in some cases can even lead to sudden death. One of the most direct dangers of obstructive sleep apnea is that it can induce hypertension. Studies have shown that 50%-60% of patients with OSAHS have hypertension and 50% of hypertensive patients have OSAHS, and scholars from various disciplines have now recognized OSAHS as an important cause of the development and exacerbation of hypertension.
Sleep apnea clinical characteristics and diagnosis
I. The main manifestations of patients with obstructive sleep apnea hypoventilation syndrome
1. Snoring
Snoring is one of the main and typical symptoms of OSAHS patients, accounting for about 70% of the patients, and it appears intermittently, irregularly, suddenly or stopping, with breathing stopping between snoring sounds, and snoring again with the recovery of breathing, generally lasting 20s-60s, a few can be as long as 2 minutes, with loud sound, suggesting upper airway obstruction.
2.Sleep apnea and suffocating awakening
Patients with OSAHS repeatedly experience transient respiratory arrest during sleep, and resume breathing with the strengthening of chest and abdominal movements or micro-awakening. Due to a variety of stimuli such as hypoxia and hypercapnia, some patients may show repeatedly suffocating awakenings, but they can mostly fall asleep quickly after waking up.
3.Morning dry mouth, headache, dizziness
OSAHS patients with upper airway obstruction often have open mouth breathing during sleep and feel dry mouth after waking up; low oxygen at night, fragmentation of sleep, and increased blood pressure in the morning can cause dizziness and headache.
Second, the blood pressure characteristics of hypertensive patients with combined OSAHS
1.Non-Arytenoid blood pressure
Blood pressure is influenced by physiological activities and sleep cycles, etc. The blood pressure of normal people and most hypertensive patients without apnea has a clear pattern of rising day and falling night. In patients with sleep apnea, the rate of blood pressure decrease at night is significantly lower or even higher than that of daytime blood pressure, i.e., blood pressure at night is non-ascending and loses its normal circadian rhythmical variation.
2.Nighttime blood pressure fluctuation
Sleep apnea patients have the lowest blood pressure at the beginning of the apnea period, with the occurrence of apnea blood pressure gradually increased, the end of the apnea blood pressure reached the highest level, the general blood pressure than before the apnea increased by 25%.
3, early morning blood pressure rise
Sleep apnea patients often have a significant increase in blood pressure in the early morning, as evidenced by a sudden rise in blood pressure before and after waking up, and then gradually decline, such changes are more obvious than the morning peak amplitude of blood pressure in non-hypertensive people.
4.Stubborn hypertension
General antihypertensive drugs can not reduce the blood pressure of patients with sleep apnea, after effective ventilator or surgery and other treatments, with the duration of apnea and SpO2 reduction correction, blood pressure can be significantly improved, and even the critical hypertension can be reduced.
Main treatment methods
I. Treatment of obstructive sleep apnea hypoventilation syndrome
1.General treatment
Every patient with obstructive sleep apnea hypoventilation syndrome should be instructed in various aspects, including weight loss, diet and weight control, appropriate exercise; abstain from alcohol, smoking, stop using sedative-hypnotic drugs and other drugs that can cause or aggravate sleep apnea; try to sleep in the lateral position, elevate the head of the bed appropriately, and avoid overexertion during the day. In addition, for those who have underlying diseases that cause or aggravate OSAHS, the underlying diseases should be treated first. For example, hypothyroidism.
2.Orthodontic appliance
It is suitable for patients with simple snoring and mild sleep apnea, especially those with mandibular recession. It can be tried for those who cannot tolerate positive airway pressure ventilation, cannot be operated or have poor surgical results. Contraindications are suffering from temporomandibular arthritis or dysfunction. The advantages are non-invasive and low price; the disadvantage is that the effect varies due to different performance of the orthoses and different tolerance of different patients.
3.Intra-airway positive pressure ventilation treatment
Including continuous positive airway pressure ventilation and bi-level positive airway pressure ventilation, continuous positive airway pressure ventilation through the mouth and nose is most commonly used. Those who have the condition can use double level positive pressure ventilation.
Second, the control of hypertension
1.Rational selection of antihypertensive drugs
Because of the increased sympathetic excitability, increased plasma catecholamines and activation of the renin-angiotensin-aldosterone system in hypertensive patients with combined OSAHS, it is believed that the application of aldosterone receptor antagonists and adrenergic receptor blockers can effectively reduce blood pressure in these patients.
2.Better protection of target organs
It is well known that the protection of target organs in hypertensive patients ultimately benefits from the smooth achievement of blood pressure, and hypertensive patients with combined OSAHS are no exception. Therefore, for such patients, only timely correction of repeated apnea-induced hypoxia and elevated sympathetic excitability, and effective control of blood pressure in the normal range, especially the normal reduction of blood pressure at night, can truly achieve the purpose of protecting the heart, brain and kidneys.