持续气道正压通气联合降压药物治疗对OSAHS合并高血压患者的降压效果观察

Antihypertensive Effects of Continuous Airway Positive Pressure Plus Antihypertensive Drugs on OSAHS Patients with Hypertension

目的探讨持续气道正压通气(CPAP)联合降压药物治疗对合并高血压的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压的影响。方法 82例OSAHS合并高血压患者随机分为对照组38例,以常规降压药物治疗;CPAP治疗组44例,在常规降压药物治疗基础上每晚加用CPAP治疗。治疗12周后,比较两组患者药物治疗的改变情况及24h血压监测等指标变化。结果 12周治疗后,除对照组夜间平均收缩压(nSBP)与治疗前差异无统计学意义外(P>0.05),CPAP组与对照组治疗后各项血压指标与治疗前均有显著差异(P<0.05),且CPAP组各项血压指标降低幅度均高于对照组。CPAP组血压降至正常率为75.0%(33/44),对照组(<140/90mmHg)为52.6%(20/38)。CPAP组有8例(18.2%)患者停用降压药,13例(29.5%)单药可维持血压于正常范围,9例(20.5%)需3种药物控制血压。对照组均需要2种或以上降压药控制血压,23例(60.6%)需3种药物控制血压。上述指标两组间均有显著差异(P<0.01)。CPAP组治疗后血压杓型改变由10例增加为29例(22.7%～65.9%,P<0.01);对照组血压杓型改变由10例增加为14例(26.3%～36.8%,P>0.05)。结论 CPAP联合药物治疗对OSAHS合并高血压患者疗效好于单纯药物治疗。对合并高血压的OSAHS患者,CPAP治疗可以减少服用降压药的品种,部分患者可停用降压药。

Objective To investigate the antihypertensive effects of continuous airway positive pressure（CPAP） plus antihypertensive drugs on patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and hypertension.Methods 82 OSAHS patients with hypertension were enrolled in this study.They were randomly divided into a CPAP treatment group（44 patients,treated with antihypertensive drugs and CPAP）,and a control group（38 patients,treated with antihypertensive drugs only）.All the patients were performed polysomnography and 24-hour blood pressure monitoring before and 12 weeks after the treatment.Results After 12 weeks treatment,except the systolic pressure in night time（nSBP）,all the parameters of 24-hour blood monitoring improved better in the CPAP group than in the control group（all P0.05）.The blood pressure dropped to normal in 75.0%（33/44） CPAP patients and in 52.6%（20/38） control patients.In the CPAP group,8（18.2%）cases were withdrawn from antihypertensive drugs,13（29.5%） cases required single agents,and 9（20.5%） cases required three agents to achieve blood pressure control.But in the control group,all the patients needed two or more antihypertensive agents,in which 23（60.6%） patients needed three agents to achieve blood pressure control.After the treatment,the patients with dipping pattern blood pressure increased from 10 to 29（22.7%-65.9%,P0.05） in the CPAP group,and from 10 to 14（26.3%-36.8%,P0.05） in the control group.Conclusions Combination therapy with CPAP and antihypertensive drugs controls blood pressure better than antihypertensive medication only for OSAHS patients with hypertension with fewer types of antihypertensive agents or even withdrawal from antihypertensive medication in some patients.