长期持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者血压影响的荟萃分析

Effect of long-term continuous positive airway pressure ventilation on blood pressure in patients with obstructive sleep apnea hypopnea syndrome:a recta-analysis of clinical trials

目的探讨长期持续气道正压(CPAP)通气能否降低阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压水平。方法用关键词途径从 MEDHNE、中国期刊全文专题数据库计算机检索系统检索2000至2006年的相关文献,将观察对象限制为 OSAHS 患者,CPAP 治疗≥4周,比较CPAP 和非 CPAP 治疗对24 h 血压影响的所有临床随机对照研究数据进行荟萃分析。结果 7项研究共471例患者被纳入荟萃分析,其中3项研究支持 CPAP 可以降低 OSAHS 患者24 h 平均舒张压;而另4项研究不支持。荟萃分析结果表明长期 CPAP 治疗可以降低 OSAHS 患者24 h 平均舒张压加权均数差:-1.78(95%CI:-3.34,-0.22)]。结论长期 CPAP 治疗可以降低 OSAHS 患者24 h 平均舒张压。

Objective To explore whether long-term continuous positive airway pressure （CPAP） ventilation is effective to decrease the blood pressure in the patients with obstructive sleep apnea hypopnea syndrome （OSAHS） accompanied with hypertension. Methods Literatures of relevant randomized, controlled, prospective, clinical trials 2000-2006 in English and Chinese were retrieved from Medline and CNKI based on the criteria： the subjects being patients with OSAHS, the study lasting at least 4 weeks, and the effect on 24 hours ambulatory blood pressure in CPAP group being compared with that in no-CPAP group. The data thus collected underwent meta-analysis. Result 471 cases in 7 studies were included. Three of the 7 studies indicated that CPAP ventilation could decrease the diastolic blood pressure in the patients with OSAHS and four studies showed no significant difference in the effect of CPAP on blood pressure between the two groups. From meta-analysis, the weighted mean difference （WMD） in fixed effect model of 24h diastolic blood pressure （DBP） was - 1.78 [ 95% CI： - 3.34, - 0.22 ] ; the WMD （fixed） of 24h systolic blood pressure （SBP） was -0.95 [95%CI： -2.85, 0.94] , and the WMD （random） of 24h mean blood pressure （MBP） was - 1.25 [ 95% CI： - 4.00, 1.49 ]. Conclusion The long-term CPAP ventilation can decrease the 24h DBP.