持续气道正压通气治疗顽固性高血压伴阻塞性睡眠呼吸暂停疗效的Meta分析

Efficay of Continuous Positive Airway Pressure for Resistant Hypertension Patients with Obstructive Sleep Apnea:A Meta-analysis

目的系统评价持续气道正压通气(CPAP)治疗顽固性高血压(RH)伴阻塞性睡眠呼吸暂停(OSA)的有效性。方法计算机检索PubMed、EMbase、The Cochrane Library(2015年10期)、CBM、CNKI和WanFang Data数据库,搜集在常规药物治疗的基础上采用CPAP与单纯常规药物治疗RH伴OSA的相关随机对照试验(RCT),检索时限均为从建库至2016年3月。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入5个RCT,共395例患者。Meta分析结果显示:在随访3个月时,CPAP组的24小时舒张压[MD=–4.79,95%CI(–7.39,–2.18),P=0.000 3]、日间舒张压[MD=–2.94,95%CI(–4.99,–0.89),P=0.005]、夜间舒张压[MD=–3.19,95%CI(–5.84,–0.55),P=0.02]、24小时收缩压[MD=–4.36,95%CI(–7.38,–1.33),P=0.005]和夜间收缩压[MD=–4.90,95%CI(–8.72,–1.08),P=0.01]降低程度明显大于对照组,但日间收缩压与对照组差异无统计学意义(P>0.05);在随访6个月时,CPAP组的24小时舒张压[MD=–4.89,95%CI(–6.76,–3.02),P<0.000 01]和日间舒张压[MD=–5.01,95%CI(–9.58,–0.45),P=0.03]降低程度明显大于对照组,但夜间舒张压、24小时收缩压、日间收缩压和夜间收缩压与对照组差异无统计学意义(P均>0.05)。结论当前证据显示,在常规药物治疗的基础上采用CPAP,可有效降低RH伴OSA患者的舒张压和短期随访时的收缩压,但对长期随访时的收缩压效果不明显。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量RCT予以验证。

Objective To Affiliated systematically review the efficacy of continuous positive airway pressure（CPAP） for resistant hypertension（RH） patients with obstructive sleep apnea（OSA）. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library（Issue 10, 2015）, CBM, CNKI and WanFang Data from inception to March 2016, to collect randomized controlled trials（RCTs） about CPAP for RH patients with OSA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, metaanalysis was performed using Rev Man 5.3 software. Results A total of 5 RCTs involving 395 patients were included. The results of meta-analysis showed that： After 3 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h diastolic blood pressure（DBP）, day DBP, night DBP, 24 h diastolic blood pressure（SBP） and night SBP of RH patients with OSA（MD= –4.79, 95%CI –7.39 to –2.18, P=0.000 3; MD= –2.94, 95%CI –4.99 to –0.89, P=0.005; MD= –3.19, 95%CI –5.84 to –0.55, P=0.02; MD= –4.36, 95%CI –7.38 to –1.33, P=0.005; MD= –4.90, 95%CI –8.72, –1.08, P=0.01）, but there was no significant difference between the two groups in day SBP. After 6 months of follow-up, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy could significantly reduce the 24 h DBP, day DBP of RH patients with OSA（MD= –4.89, 95%CI –6.76 to –3.02, P0.000 01; MD= –5.01, 95%CI –9.58 to –0.45, P=0.03）, but there were no significant differences between the two groups in night DBP, 24 h SBP, day SBP, and night SBP. Conclusions Current evidence suggests that CPAP on the basis of antihypertensive drug therapy could effectively reduce the DBP and SBP of RH patients with OSA at short-term follow-up, but the long-term effect on SBP is not obvious. Due to limited quality and quantity of the included studies, the above conclusions need to be verified by more high quality studies.