快速眼球运动睡眠期阻塞性呼吸暂停事件对动态血压的影响及机制研究

Many studies have demonstrated that obstructive sleep apnea (OSA) is a risk factor of hypertension, whereas Rapid Eye Movement (REM) sleep related OSA is independently associated with hypertension in patients with OSA. The hyperactivity of sympathetic nervous system, systemic inflammation and Hypothalamic Pituitary Adrenal (HPA) are related to the pathological changes in the development of hypertension in patients with OSA. We speculate, 1) the impact of OSA during REM sleep on 24 hours ambulatory blood pressure, sympathetic nervous system, systemic inflammation and HPA are higher than those during Non-REM (NREM) sleep; 2) eliminating OSA events during REM sleep utilizing Continuous Positive Airway Pressure (CPAP) can effectively reverse the abnormity of those physiological indicators, which may provide evidences in the treatment for OSA specifically during REM sleep. We proposed the studies in patients with OSA to explore, 1) the impacts of hyperactivity of sympathetic nervous system and neuroendocrine during REM sleep on 24 hours ambulatory blood pressure; (2) whether eliminating OSA specifically during REM sleep can effectively reduce blood pressure? and thus further to clarify the possible mechanisms. The outcomes of this research plan would be valuable in further understanding the pathological mechanisms of hypertension and optimizing clinical treatment strategies for OSA patients.

大量研究证实阻塞性睡眠呼吸暂停（OSA）是高血压患病的风险因素。在OSA患者中，发现快速眼球运动睡眠期（REM）的OSA事件是高血压患病的独立危险因素。交感神经活性、系统性炎症反应及下丘脑-垂体-肾上腺（HPA）轴活动增高可能是OSA患者高血压发生的病理生理学机制。我们推测：1）OSA患者REM期呼吸事件对24小时血压、交感神经活性、系统性炎症反应及HPA轴影响高于NREM期；2）通过持续气道正压通气（CPAP）治疗仅消除REM期的呼吸事件可有效改善OSA患者上述生理指标，可能为针对REM期相关的OSA提供治疗依据。我们计划通过对OSA患者的研究，探讨：1）OSA患者REM期交感神经活性及神经内分泌的异常变化对动态血压的影响；2）针对REM期的CPAP治疗是否能有效的降低OSA患者动态血压，并阐明相关机制。为深入了解OSA患者高血压的发病机制及优化OSA治疗策略提供理论基础。

阻塞性睡眠呼吸暂停（Obstructive sleep apnea, OSA）是最常见的睡眠呼吸障碍，快速眼球运动睡眠期（REM）的OSA事件有其独特的生理特征，可能在OSA相关的高血压防治中起关键作用。本项目紧密围绕这一核心问题，应用具有国际前沿水平的研究技术，采用多模态的研究策略，从疾病特征、神经功能、血液生化等方面对健康受试和OSA患者进行独立比较分析。建立了OSA综合数据库；阐明了OSA患者REM期呼吸事件对24小时血压的影响及可能机制；明确了针对性消除REM期呼吸事件对OSA相关血压调控有效性。为深入了解OSA相关高血压的病理机制及临床评估和寻找有效治疗的生物靶标奠定理论基础及提供指导方向。