持续正压通气对阻塞性睡眠呼吸暂停低通气患者血压影响差异分析

Effect of Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea-Hypopnea Syndrome

背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是高血压的独立危险因子,持续正压通气是其有效治疗方式。然而,持续正压通气(CPAP)对血压影响的结论并不统一。目的分析 CPAP 对 OSAHS 患者血压的影响。方法对2000-01—2008-01间 CPAP 对血压影响的论文进行检索,筛选经有效 CPAP 治疗不少于两周且治疗前后血压数据完整的随机试验,并对相关数据进行分析。结果经筛选,纳入相关文献16篇、共1309人。CPAP治疗组治疗前后收缩压降低5.4 mmHg(95%CI:2.9～7.8),舒张压降低3.9 mmHg(95%CI:1.9～5.9);持续正压通气后收缩压降低组与未降低组初始收缩压存在显著差异(144.5 mmHg vs 140.0 mmHg,P<0.05)。结论对于合并 OSAHS 的高血压患者,有效的 CPAP 治疗有利于控制血压,且初始血压高的 OSAHS 患者经有效 CPAP 后血压降低明显。但是,对血压的效益大小应根据初始血压情况、呼吸紊乱程度、嗜睡程度(ESS)进行综合评定。

Background Sleep apnea-hypopnea syndrome （OSAHS） is an independent risk factor for hypertension. Continuous positive airway pressure （CPAP） has been recognized as an effective way to treat OSAHS. However, reports of effect of CPAP on BP are at variance. Objective To Meta-analysis the impact of CPAP therapy on blood pressure in patients with OSAHS. Methods Sixteen reports between 2001 to 2008 were included that compared CPAP to control with minimum treatment duration of 2 weeks. Results Data from 16 trials comprise 1309 participants. Mean net decreases in SBP for those treated with CPAP was 5.4 mmHg（95%CI： 2.9--7.8） ; 3.9 mmHg in DBP（95%CI： 1.9-5.9）. The baseline SBP was significant higher in responsive patients than that without responses（144.5 mmHg vs 140.0 mmHg,P〈0.05）. Conclusion Patients with OSAHS and hypertension should accept effective continuous positive airway pressure. Potential benefit of CPAP administration on blood pressure will be various according to severity of hypertension, obstructive sleep apnea, antihypertensive and severity of daytime hypersomnolence.