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 All antihypertensive drugs were withdrawn.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.

Key words: Sleep apnea, obstructive, Brain ischemia, Blood pressure determination, Circadian rhythm, Polysomonography

摘要： 目的 探讨缺血性卒中合并阻塞性睡眠呼吸暂停综合征（OSAS）对血压节律的影响，从而更好地控制血压、预防脑卒中。方法 选择符合纳入条件的受试者分为缺血性卒中合并OSAS 组（合并症组）、缺血性卒中组和正常对照组，经详细询问病史、影像学检查、血压和多导睡眠图监测，评价高血压患病率以及睡前和晨起血压水平。结果 （1）合并症组和缺血性卒中组患者高血压和难治性高血压患病率（P = 0.000，0.000）均高于对照组，其中缺血性卒中组以收缩压升高为主（P = 0.000，0.002）、合并症组以舒张压升高为主（P = 0.002，0.042），两组收缩压和舒张压均升高的患病率均高于对照组（P = 0.000，0.045）。（2）合并症组患者睡前和晨起高血压患病率均高于对照组（P = 0.000，0.000），且晨起高血压患病率高于缺血性卒中组（P = 0.000）；而缺血性卒中组仅睡前高血压患病率高于对照组（P = 0.002）。（3）合并症组和缺血性卒中组患者睡前（P = 0.000，0.020）和晨起（P = 0.000，0.004）收缩压均高于对照组，合并症组患者睡前（P = 0.000，0.000）和晨起（P = 0.000，0.000）舒张压则分别高于缺血性卒中组和对照组；仅合并症组患者睡前和晨起舒张压之间差异有统计学意义（P = 0.000）。结论 缺血性卒中患者以单纯收缩压升高为主要表现，合并阻塞性睡眠呼吸暂停综合征后则易导致收缩压和舒张压同时升高，使血压昼夜节律发生变化。

关键词: 睡眠呼吸暂停, 阻塞性, 脑缺血, 血压测定, 昼夜节律, 多道睡眠描记术