夜间持续气道正压通气有助于降低中重度阻塞性睡眠呼吸暂停综合征伴高血压患者的收缩压

Continuous positive airway pressure contributes to the control of systolic blood pressure in patients with moderate to severe obstructive sleep apnea syndrome and hypertension

背景阻塞性睡眠呼吸暂停综合征(OSAS)与高血压相关,持续气道正压通气(CPAP)可有效改善OSAS患者的睡眠情况,但在血压控制方面的效果尚存争议。目的探究CPAP在中重度OSAS合并高血压患者血压控制中的作用。方法选取阜外心血管病医院高血压诊治中心2010年9月至2014年9月诊断为中重度OSAS合并高血压患者117例进行回顾性分析(失访31例),其中对照组65例,只给予常规降压药物治疗;CPAP治疗组52例,除常规药物治疗外加用CPAP治疗。每3月随访1次,2014年10月1日截止,对照组随访(41.95±22.18)月,CPAP组随访(39.43±24.74)月(P>0.05)。比较两组患者血压变化情况,分析CPAP对OSAS合并高血压患者血压的影响。结果除糖尿病比例外,两组患者基本情况的差异无统计学意义,CPAP组呼吸暂停低通气指数、氧减饱和度指数更高。经过治疗后,CPAP组收缩压下降较对照组更明显[(12.6±18.1)比(4.5±16.8)mm Hg,P=0.02],但两组舒张压下降的差异无统计学意义[(10.0±12.4)比(6.9±15.0)mm Hg,P=0.23],并且治疗组增加降压药种类的患者明显少于对照组(2.0%比20.3%,P<0.01)。结论 CPAP可在药物治疗基础上进一步降低中重度OSAS合并高血压患者的收缩压。

Background Obstructive sleep apnea syndrome （OSAS） is related to hypertension. Continuous posi- tive airway pressure （CPAP） could improve the quality of sleep in patients with OSAS. However, it is unclear whether CPAP has a positive effect on blood pressure control. Objective To examine the effects of CPAP on blood pressure control in patients with moderate to severe OSAS and hypertension. Methods In this retrospective study, 117 hypertensive patients with moderate to severe OSAS visiting hypertension center of Fuwai Hospital between Sep- tember 2010 and September 2014 were included （31 patients dropped out）. Patients were divided into CPAP group （treated by regular antihypertensive medications plus CPAP treatment, n= 52） and control group （regular antihyper- tensive medications only, n=65）. Patients were followed up every 3 months until October 1st, 2014 with an aver- age follow up time of （39. 43±24.74） months in CPAP group and （41.95±22. 18） months in the control group （P〉0.05）. The changes in blood pressure were compared between the groups, and the efficacy of CPAP on blood pressure was evaluated. Results Except the proportion of patients with diabetes, there was no difference in base- line patients＇ info. The apnea-hypopnea index （AHI） and the oxygen desaturation index （ODI） were higher in CPAP group. After CPAP treatment, the decrease of systolic blood pressure in the CPAP group was significantly larger than that in the control group [（12.63±18.1） vs （4.53±16.8） mm Hg, P=0.02], but there was no differ- ence in the decrease of diastolic blood pressure [（10.0±12.4） vs （6.93±15.0） mm Hg, P=0.23]. Furthermore,the percentage of patients needed more antihypertensive drugs in the CPAP group was significantly less than control group （2.0% vs 20.3%, P〈0.01）. Conclusions On top of medication, CPAP could further decrease systolic blood pressure in patients with moderate to severe OSAS and hypertension.