CPAP对OSAS合并顽固性高血压和糖尿病患者的降压效果及对糖代谢的影响

Effect of CPAP on the glucose metabolism and antihypertension in OSAS patients with resistant hypertension complicated with diabetes

目的:探讨持续气道无创正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)合并顽固性高血压和糖尿病患者降压效果及对糖代谢的影响。方法:将OSAS合并顽固性高血压和2型糖尿病患者89例随机分为2组,对照组42例以常规降压药物和降糖药物治疗;CPAP组47例在常规降压药物和降糖药物治疗基础上每晚加用CPAP治疗6 h。治疗3个月后,比较2组24 h血压各项血压指标和空腹血糖。结果:治疗3个月后,CPAP组和对照组24 h平均收缩压、24 h平均舒张压、白天平均收缩压、白天平均舒张压、夜间平均收缩压和夜间平均舒张压均较治疗前显著降低(P<0.01),CPAP组各项血压指标降低幅度均明显高于对照组(P<0.01)。CPAP组治疗前空腹血糖≤7.0 mmol/L 10例(23.8%),治疗结束后空腹血糖≤7.0 mmol/L35例(83.3%),对照组治疗前、后空腹血糖≤7.0 mmol/L均为5例(12.5%)。结论:CPAP联合药物治疗对OSAS合并顽固型高血压和糖尿病患者疗效好于单纯药物治疗。

Objective： To investigate the effects of non-invasive continuos positive airway pressure（ CPAP） on the glucose metabolism and antihypertension in bbstructive sleep apnea syndrome（ OSAS） patients with resistant hypertension complicated with diabetes.Methods： Eighty-nine OSAS patients with resistant hypertension complicated with type 2 diabetes were randomly divided into the CPAP group（ n = 47,treated with antihypertensive drugs,hypoglycemic agents combined with CPAP for 6 h every night） and control group（ n= 42,treated with antihypertensive drugs combined with hypoglycemic agents）. The 24 h blood pressure and fasting blood glucose between two groups were compared after three month of treatment. Results： Compared with before treatment,the levels of 24 h SBP,24 h DBP,d SBP,d DBP,n SBP and n DBP in the two groups decreased significantly after three months of treatment（ P〈0. 01）. The decreasing degree of the blood pressure parameters in CPAP group was significantly higher than those in control group（ P〈0. 01）. The fasting blood glucose less than or equal to 7. 0 mmol / L in 10 cases（ 23. 8%） and 35 cases（ 23. 8%） were found in CPAP group before and after treatment,respectively. The fasting blood glucose less than or equal to 7. 0 mmol / L in 5 cases（ 12. 5%） and 5 cases（ 12. 5%） were found in control group before and after treatment,respectively. Conclusions： The treatment effects of CPAP combined with drugs on OSAS patients with resistant hypertension complicated with diabetes are better than the pure drug treatment.