Sleep Apnea Syndrome (SAS) is a common sleep apnea disorder, and with the in-depth research, the close relationship between SAS, especially Obstructive Sleep Apnea Syndrome (OSAS), and hypertension has been issued in recent years.
Characteristics of OSAS combined with hypertension.
1, OSAS as an independent risk factor causing hypertension (obesity, age, genetics, smoking).
2. a causal relationship between OSAHS and hypertension.
3. the prevalence of OSAHS among hypertensive patients is 30-50%.
4. hypertension caused by OSAHS is mostly refractory hypertension, which is poorly treated with drugs alone.
5. The elevated blood pressure in patients with severe OSAHS occurs mostly at night and early in the morning, and is difficult to detect unless 24-hour blood pressure monitoring is performed.
Diagnosis of OSAS combined with hypertension.
1. awareness raising, considering hypertension secondary to possible OSAS.
2. Ancillary tests: polysomnography (PSG) and 24-hour ambulatory blood pressure monitoring.
3. Initial screening of patients: ESS Sleepiness Scale, BMI.
Treatment of OSAS combined with hypertension.
1.Remove the cause of the disease
2.Drug treatment
Angiotensin-converting enzyme inhibitors (ACEI) are more suitable for the treatment of OSAS combined with hypertension: 1.
1.Calcium channel blockers (CCB) and β-blockers, diuretics are generally effective and have adverse effects on sleep itself.
2, colistin class antihypertensive drugs can aggravate the sleep breathing disorder, so it is not recommended.
(1) Non-invasive ventilation therapy.
Including transnasal continuous positive pressure ventilation (nCPAP) and bi-level positive airway pressure ventilation (BiPAP), etc.
(2) Surgical treatment.
Nasal plane surgery (partial inferior turbinate resection, nasal polypectomy, correction of deviated nasal septum, etc.).
Oropharyngeal plane surgery (palatopharyngoplasty, soft palate perforation ablation, uvulopalatal truncation, etc.).
Ligopharyngeal plane surgery (tongue root perforation ablation, tongue root partial resection, tongue lymphatic tissue ablation, etc.).
Remind refractory hypertensive patients with snoring and apnea during sleep can be considered to be due to obstructive sleep apnea syndrome, and 24-hour blood pressure monitoring and polysomnography are recommended to clarify the diagnosis. Generally, blood pressure can be better controlled after the primary disease is controlled!