伴阻塞性睡眠呼吸暂停低通气综合征高血压患者的血压控制研究

Blood pressure control in hypertensive patients with obstructive sleep apnea hypopnea syndrome

目的探讨伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高血压患者,同时服用降压药和接受持续气道正压通气(CPAP)是否能有效控制血压。方法选取2014年1月至2015年6月南京医科大学第一附属医院睡眠中心就诊的伴有OSAHS高血压患者180例,根据服用降压药物后血压是否被有效控制,分为控制组(n=87)和未控制组(n=93),两组在服用降压药同时接受CPAP 6个月,比较服用不同降压药方案和CPAP治疗前后血压是否得到有效控制的关系。结果所有患者共使用13种不同的降压药方案进行治疗。控制组与未控制组患者降压药方案差异无统计学意义(P>0.05),多因素logistic回归分析表明降压药方案不是影响伴OSAHS高血压患者血压控制的独立预测因子(OR=1.897,P=0.094)。使用CPAP后控制组、非控制组夜间收缩压(SBP)和舒张压(DBP)均下降,差异有统计学意义(P<0.01)。结论伴OSAHS高血压病患者的降压治疗方案与血压控制无明显相关性,而CPAP治疗可使降压药有效组和无效组患者的夜间血压都降低。

Objective To investigate whether antihypertensive medication and continuous positive airway pressure （CPAP） treatment can effectively control blood pressure （Bp） in the hypertensive patients with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A total of 180 hypertensive patients with OSAHS admitted in the First Affiliated Hospital of Nanjing Medical University from January 2014 to June 2016 were recruited in this study. According to the outcome of hypertensive medication, they were divided into Bp controlled group （n=87） and Bp uncontrolled group （n=93）. Then they were given CPAP treatment and hypertensive medication simultaneously for 6 months. Bp control results were compared among the patients undergoing different regimens of antihypertensive medications, and the relationship of Bp well-control with CPAP treatment was analyzed. Results A total of 13 different antihypertensive regimens were used among the enrolled subjects. There was no statistical difference in the regimen distribution between the Bp controlled group and Bp uncontrolled group （P〉0.05）. Multivariate factor logistic regression analysis revealed that antihypertensive regimen was not an independent predictor of Bp control outcome in the hypertensive patients with OSAHS （OR=1.897,P=0.094）. However, CPAP treatment obviously decreased nocturnal systolic blood pressure （SBP） and diastolic blood pressure （DBP） in both the Bp controlled and uncontrolled groups （P〈0.01）. Conclusion In hypertensive patients with OSAHS, there is no significant association between antihypertensive medication regimens and Bp control. Additional CPAP treatment could further reduce nocturnal Bp in both Bp controlled and uncontrolled patients after antihpertensive medication.