持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并难治性高血压患者血压及相关炎性因子的影响

Effect of continuous positive airway pressure on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome complicated with refractory hypertension

目的探讨持续气道正压(CPAP)通气对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并难治性高血压患者血压的变化及相关炎性因子的影响,并探究呼吸功能与炎性因子的相关性。方法将2014年1月至2018年9月就诊于深圳市南山区人民医院的OSAHS合并难治性高血压患者随机分为CPAP组和对照组。对照组予以常规治疗,CPAP组在常规治疗的基础上予以CPAP通气,各干预7 d。测量两组干预前及第1、3、5、7 d后收缩压和舒张压,检测干预7 d后呼吸功能状况及其相关炎性因子。结果经过CPAP 7 d后,CPAP组呼吸暂停低通气指数(AHI)、最低血氧饱和度及氧减指数水平较干预前显著改善,同时其呼吸功能状况改善程度显著高于常规对照组干预7 d后改善程度。CPAP组第1、3、5、7 d后收缩压和舒张压水平显著低于对照组;第7 d后收缩压和舒张压均低于干预前水平。干预7 d后对照组及CPAP组相关炎性因子均显著改善(均P<0.05),而CPAP组血清高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及内皮素-1(ET-1)水平较对照组常规治疗7 d后相关炎性因子仍有显著降低(均P<0.05)。干预后CPAP组AHI水平与hs-CRP、IL-6、TNF-α及ET-1呈显著的正相关(P<0.001)。结论CPAP能显著改善OSAHS合并难治性高血压患者的血压状况。CPAP可能通过改善患者的呼吸功能改善其相关炎性因子,继而降低患者的血压。

Objective To investigate the effects of continuous positive airway pressure(CPAP) ventilation on blood pressure and related inflammatory factors in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)and refractory hypertension, and explore the correlation between respiratory function and related inflammatory factors.Methods Patients with OSAHS and refractory hypertension who visited Shenzhen Nanshan People’s Hospital between January 2014 and September 2018 were randomly divided into a CPAP group and a control group. The control group received routine treatment. The CPAP group received CPAP on the basis of conventional treatment.Each intervention lasted for 7 days. The changes of systolic and diastolic blood pressure were measured before and after 1, 3, 5, and 7 days, respectively. The respiratory function and related inflammatory factors were measured after7 days of intervention. Results After 7 days of treatment in the CPAP group, the levels of apnea hyperpnoea index(AHI), lowest oxygen saturation and oxygen desaturation index were significantly better than those before intervention, with the improvement of respiratory function significantly higher than that of the control group after 7 days.Meanwhile the systolic and diastolic blood pressure levels were significantly lower in the CPAP group than those of the control group at 1, 3, 5, and 7 days, and lower than the pre-intervention after 7 days of intervention. After 7 days of intervention, the inflammatory factors in both groups were significantly improved(all P<0.05). However, the serum levels of high sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and endothelin-1(ET-1) in the CPAP group were significantly lower than those of the control group after 7 days of treatment(P<0.05).There was a significant positive correlation between AHI level and hs-CRP, IL-6, TNF-α and ET-1 in the CPAP group after intervention(P<0.001). Conclusions CPAP can significantly improve the blood pressure of patients with OSAHS and refractory hypertension. CPAP may improve the related inflammatory factors by improving the respiratory function of patients, thus reduce the patient’s blood pressure.