气道正压通气治疗对老年高血压合并睡眠呼吸暂停低通气综合征血压变异性的影响

Effects of AUTO-CPAP on blood pressure variability in elderly hypertensive patients with obstructive sleep apnea syndrome

目的探讨自动调节持续气道正压通气(AUTO-CPAP)治疗对老年原发性高血压(EH)合并睡眠呼吸暂停低通气综合征(OSAHS)患者血压变异性(BPV)的影响。方法临床确诊60例EH合并OSAHS老年患者,根据睡眠呼吸暂停低通气指数(AHI)及夜间最低氧饱和度(SaO2min),分为EH合并轻度OSAHS组(5<AHI≤20,SaO2min为85%～89%)17例及EH合并中重度OSAHS组(AHI>20,SaO2min<85%)43例,在给予原有的抗高血压药物治疗同时,行AUTO-CPAP治疗20 d,治疗前后分别进行动态血压测定,比较患者BPV的变化。以各时间段血压的标准差(SD)作为血压变异的指标:24 h收缩压变异(24hSSD)和舒张压变异(24hDSD)、白昼收缩压变异(dSSD)和白昼舒张压变异(dDSD)、夜间收缩压变异(nSSD)和夜间舒张压变异(nDSD)。结果EH合并轻度OSAHS患者,行AUTO-CPAP治疗后与治疗前比较,患者的24hSSD、24hDSD、dSSD、dDSD、nDSD无显著差异(P>0.05),nSSD有显著差异(P<0.05)。EH合并中重度OSAHS组,行AUTO-CPAP治疗后与治疗前比较,24hDSD、dDSD无显著差异(P>0.05),24hSSD、dSSD、nDSD、nSSD有显著差异(P<0.05或P<0.01)。结论在原有高血压药物治疗同时,AUTO-CPAP治疗可显著改善EH合并OSAHS患者的BPV,较EH合并轻度OSAHS患者而言,EH合并中重度OSAHS患者的BPV的改善可能更为明显。

Objective To study the effects of auto-continuous positive airways pressure（AUTO-CPAP） on blood pressure variability in elderly essential hypertensive（EH） patients with obstructive sleep apnea/hypopnea syndrome（OSAHS）. Methods Sixty elderly EH patients with OSAHS were enrolled,according to apnea hypopnea index（AHI） and nocturnal lowest SaO2（SaO2min）.Seventeen cases of EH with mild OSAHS（5〈AHI≤20,SaO2min 85%～89%） and 43 EH with moderate or severe OSAHS（AHI〉20,SaO2min〈85%）,were given routine antihypertensive and AUTO-CPAP treatment for 20 days.All patients received 24 h blood pressure monitoring before and after treatment.The variations of blood pressure variability（BPV） were recorded.BPV was measured by means of the standard deviation（SD） of systolic and diastolic pressures during 24 hour and circadian：24hSSD,24hDSD,dSSD,dDSD,nSSD and nSSD. Results After treatment of AUTO-CPAP,there were significant difference in the variations of nSSD in EH with mild OSAHS patients（P〈0.05）,the variations of 24hSSD,24hDSD,dSSD,dDSD and nDSD were not significant（P〉0.05）.After treatment of AUTO-CPAP,the variations of 24hDSD,dDSD were not significant（P〉0.05）,the variations of 24hSSD,dSSD and nDSD were significant（P〈0.05）,the variations of nSSD were more significant（P〈0.01） in EH with moderate or severe OSAHS patients. Conclusions During the routine antihypertensive treatment,AUTO-CPAP can significantly modify BPV in elderly EH patients with OSAHS.Compared with EH patients with mild OSAHS,the change is more obvious in moderate or severe OSAHS patients.