短期持续气道内正压通气治疗对不同程度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者的降压疗效比较

Hypotensive efficacy of short-term continuous positive airway pressure therapy for obstructive sleep apnea/hypopnea syndrome patients complicated with hypertension

目的探讨短期持续气道内正压通气（CPAP）治疗对不同程度阻塞性睡眠呼吸暂停综合征（OSAHS）合并高血压患者的降压疗效差异。方法入选2012年11月至2013年5月在新疆维吾尔自治区人民医院高血压科住院经多导睡眠监测确诊的OSAHS合并高血压患者100例，根据OSAHS病情将研究对象分为：轻度组[5≤呼吸暂停低通气指数（AHI）〈15]13例、中度组（15≤AHI〈30）26例与重度组（AHI≥30）61例，在原有降压药物治疗基础上给予连续每日夜间CPAP治疗（〉611／晚）1周，监测3组患者每日血压水平，比较各组治疗前后血压及血压达标率，分析短期CPAP治疗对不同程度0SAHS合并高血压患者的降压疗效差异。结果重度组CPAP治疗第7天晨起收缩压[（133．7±14．2）mmHg比（139．0±15．6）mmHg（1mmHg=0．133kPa）]、晨起舒张压[（84．8±10．0）mmHg比（92．0±12．6）mmHg]、晨起平均动脉压[（101．1±10．4）mmHg比（107．5±12．3）mmHg]均低于治疗前，晨起平均动脉压下降幅度[（8．9±12．9）mmHg比（3．7±10．1）mmHg，P〈0．05]大于第1天，晨起收缩压达标率（82．0％比54．1％）、晨起舒张压达标率（86．9％比36．1％）高于治疗前，均P〈0．05。中度组CPAP治疗第7天晨起舒张压[（87．1±9．9）mmHg比（92．5±10．1）mmHg]、晨起平均动脉压[（104．2±8．7）mmHg比（109．3±10．8）mmHg]均低于治疗前，晨起收缩压达标率（80．8％比30．8％）、晨起舒张压达标率（77．0％比30．8％）高于治疗前，均P〈0．05。轻度组治疗前后各指标比较差异无统计学意义（P〉0．05）。重度组CPAP治疗第7日晨起收缩压、晨起舒张压均低于轻度组（均P〈0．05）。重度组、中度组CPAP治疗第7日晨起平均动脉压低于轻度组（均P〈0．05），晨起收缩压达标率、晨起舒张压达标率均高于轻度组（均P〈0．05）。结论短期CPAP治疗对于中、重度OSAHS合并高血压患者的降压疗效显著。

Objective To investigate the hypotensive effects of short-term continuous positive airway pressure （CPAP） therapy on obstructive sleep apnea/hypopnea syndrome （OSAHS） patients complicated with hypertension. Methods One hundred OSAHS patients complicated with hypertension admitted in department of hypertension at the People＇s Hospital of Xinjiang Uygur Autonomous Region from November 2012 to May 2013 were enrolled in the study, including 13 mild cases （5 ≤ apnea/hypopnea index, AHI 〈 15 ）, 26 moderate cased （ 15 ≤ AHI 〈 30） and 61 severe cases （ AHI≥ 30）. Nocturnal CPAP therapy was given to all patients for 7 days （ 〉 6 h/night） on the basis of antihypertensive medications. The daily blood pressure was monitored, and the blood pressure was compared before and after treatment in three groups of patients. Results In severe OSAHS group the morning systolic blood pressure [ （ 133.7 ± 14. 2） mmHg vs. （ 139.0 ± 15.6） mmHg（ 1 mmHg = 0. 133 kPa） , P 〈 0. 05 ] , diastolic blood pressure [ （ 84. 8 ± 10. 0 ）mmHg vs. （92. 0 ± 12. 6 ） mmHg, P 〈 0. 05 ] and mean blood pressure [ （ 101.1 ± 10. 4 ） mmHg vs. （ 107.5 ± 12. 3 ） mmHg, P 〈 0. 05 ） ] was significantly decreased after treatment ; the extent of mean blood pressure decrease [ （ 8.9 ± 12. 9 ） mmHg vs. （ 3.7 ± 10. 1 ） mmHg, P 〈 0.05 ] at day 7 was significantly greater than that at day 1, the normalization rates of systolic blood pressure and diastolic blood pressure after treatment were significantly higher than those before treatment （82. 0% vs. 54. 1%, P 〈0. 05 and 86.9% vs. 36. 1% , P 〈 0. 05 ）. In moderate OSAI-IS group the morning diastolic blood pressure [ （ 87.1 ± 9.9 ） mmHg vs. （92. 5 ± 10. 1 ） mmHg, P 〈 0. 05 ] , mean arterial pressure [ （ 104. 2 ± 8.7 ） mmHg vs. （ 109. 3 ± 10. 8 ）mmHg, P 〈 0. 05 ] were significantly lowered at day 7 of treatment, the normalization rates of systolic blood pressure and diastolic blood pressure at day 7 were higher than those before treatment （80. 8% vs. 30. 8%, P 〈 0. 05 and 77. 0% vs. 30. 8% , P 〈 0. 05 ）. Whereas there were significant differences in those indexes of mild OSAHS group before and after treatment. Conclusion Short-term CPAP therapy can effectively lower blood pressure for moderate and severe OSAHS patients complicated with hypertension.