持续气道正压通气对冠心病合并阻塞性睡眠呼吸暂停患者血压和昼间嗜睡的影响

Effect of Continuous Positive Airway Pressure on Blood Pressure and Daytime Sleepiness in Patients of Coronary Artery Diseases Combined With Obstructive Sleep Apnea

目的:探讨持续气道正压通气(CPAP)对冠心病合并阻塞性睡眠呼吸暂停(OSA)患者血压和昼间嗜睡的影响。方法:入选24例冠心病合并中重度OSA的患者(简称CPAP组),进行1个月的CPAP治疗加最优化的药物治疗;同时选择24例匹配的患者作为对照组,仅给予最优化的药物治疗。基线时记录所有患者的人口学特征、多导睡眠监测的数据等。治疗1个月后,复查两组患者的诊室血压、心率、Epworth嗜睡评分等。结果:与对照组相比,CPAP组舒张压降低,两组的变化值比较差异有统计学意义(CPAP组Δ-5.1±6.5 vs对照组Δ-0.8±6.0(P=0.023);并改善Epworth嗜睡评分(CPAP组Δ-5.2±3.1 vs对照组Δ-0.5±3.2,P<0.001)。结论:对于最优化药物治疗的冠心病合并中重度OSA的患者,1个月的CPAP治疗可以显著降低晨起舒张压,改善昼间嗜睡。

Objective：To explore the effect of continuous positive airway pressure （CPAP）on blood pressure and daytime sleepiness in patients of coronary artery diseases（CAD） combined with obstructive sleep apnea（OSA）. Methods：Our work included two groups of CAD patients with moderate to severe OSA,n = 24 in each group. CPAP group, the patients received 1 month of CPAP treatment with the optimal medication, and Control group, the matched patients with the optimal medication alone. Baseline demographic characteristics and sleep study information were recorded and clinical blood pressure, heart rate, Epworth sleepiness scale score were examined and compared between groups after 1 month treatment. Results：Compared with Control group, with 1 month treatment, CPAP group presented reduced diastolic blood pressure （ △-0. 8 ±6. 0 vs. △-5. 1 ±6. 5, P = 0. 023 ）, and improved Epworth sleepiness scale scores （ △ - 0. 5± 3.2 vs. △- 5.2 ± 3.1, P 〈 0. 001）. Conclusion：For CAD patients combined with moderate to severe OSA, the optimal medication plus 1 month CPAP treatment could obviously decrease the diastolic blood pressure and improve the daytime sleepiness.