The effect of ischemic stroke combined with obstructive sleep apnea syndrome on circadian blood pressure

Abstract

Objective To investigate the effect of ischemic stroke combined with obstructive sleep apnea syndrome (OSAS) on circadian blood pressure. Methods Sixty-five ischemic stroke patients combined with OSAS (combined group), 51 ischemic stroke patients without OSAS (ischemic stroke group), and 76 healthy subjects (control group) were enrolled in this study. History of hypertension was inquired, and blood pressure and polysomnography (PSG) were monitored. All antihypertensive drugs were withdrawn. The morbidity rate of hypertension, and levels of pre-sleep and morning blood pressure were assessed. Results The morbidity rate of hypertension and refractory hypertension in combined group and ischemic stroke group were higher than control group (P = 0.000, 0.000). The prevalence of simple high systolic blood pressure (SBP) in ischemic stroke group was higher than other 2 groups (P = 0.000, 0.002), and the prevalence of simple high diastolic blood pressure (DBP) in combined group was higher than control group and ischemic stroke group (P = 0.002, 0.042), while the prevalences of high SBP and DBP in combined group and ischemic stroke group were all higher than control group (P = 0.000, 0.045). The prevalence of pre-sleep hypertension and morning hypertension in combined group were all higher than control group (P = 0.000, 0.000), and the prevalence of morning hypertension in combined group was also higher than ischemic stroke group (P = 0.000), while only the prevalence of pre-sleep hypertension in ischemic stroke group was higher than control group (P = 0.002). The difference of prevalence of pre-sleep hypertension between combined group and ischemic stroke group was not statistically significant (P = 0.347). The pre⁃sleep SBP (P = 0.000, 0.020) and morning SBP (P = 0.000, 0.004) in combined group and ischemic stroke group were all higher than control group, but the difference between combined group and ischemic stroke group was not statistically significant (P = 0.074, 0.100); the pre-sleep DBP (P = 0.000, 0.000) and morning DBP (P = 0.000, 0.000) in combined group were higher than the ischemic stroke group and control group, but the difference of pre⁃sleep DBP and morning DBP between ischemic stroke group and control group was not statistically significant (P = 0.059, 0.054). The differences of pre⁃sleep SBP and morning SBP in combined group, ischemic stroke group and control group were not statistically significant (P = 0.702, 0.329, 0.503), but the difference of pre⁃sleep DBP and morning DBP in combined group was statistically significant (P = 0.000), while the differences of pre-sleep DBP and morning DBP in ischemic stroke group and control group were not statistically significant (P = 0.058, 0.318). Conclusion Isolated systolic hypertension is the main manifestation of ischemic stroke patient. When the patient is combined with OSAS, SBP and DBP are liable to elevate, and the circadian rhythm of blood pressure may be affected.