高血压合并睡眠呼吸暂停综合征患者应用持续正压通气治疗血压节律变化研究

Continuous positive airway pressure treatment on blood pressure rhythm in hypertension patients with obstructive sleep apnea

目的探讨持续正压通气治疗对高血压合并睡眠呼吸暂停综合征患者血压及血压节律的影响。方法连续入选2020年至2022年就诊的高血压合并阻塞性睡眠呼吸暂停综合征患者,随机分为持续气道正压通气(CPAP)治疗组和对照组。两组均常规应用降压药物治疗,持续气道正压通气治疗组给予患者夜间每晚大于4 h持续正压通气治疗。治疗12周查24 h动态血压,并依据血压结果分析血压节律分型。结果完成实验共104例,年龄40~73岁,其中CPAP组51例,平均(57.3±9.1)岁,男性58.8%;对照组53例,平均(58.3±8.1)岁,男性54.7%。24 h动态血压监测结果显示CPAP组降压效果更显著,CPAP组较对照组24 h平均收缩压(SBP)[(134.6±8.4)mmHg和(138.2±5.9)mmHg,t=-2.54,P=0.013]、24 h平均舒张压(DBP)[(72.4±9.3)mmHg和(77.0±9.0)mmHg,t=-2.56,P=0.012]、夜间平均SBP[(117.2±5.1)mmHg和(122.0±6.2)mmHg,t=-4.283,P<0.01]及夜间平均DBP[(63.7±6.4)mmHg和(66.9±5.1)mmHg,t=-2.812,P<0.01]均有显著性差异。两组对比发现CPAP组勺型血压患者明显增多(37.3%和18.9%,χ^(2)=4.370,P=0.037)。结论高血压合并睡眠呼吸暂停综合征患者应用持续正压通气治疗,可显著降低患者24 h平均血压及夜间血压,并改善患者血压节律。

Objective To investigate the effect of continuous positive airway pressure(CPAP)on blood pressure and blood pressure rhythm in hypertensive patients with sleep apnea syndrome.Methods Hypertensive patients with obstructive sleep apnea syndrome consecutively recruited between 2020 and 2022 were randomly divided into two groups,the CPAP group and the control group.Both groups were routinely treated with antihypertensive drugs,and patients in the CPAP group were additionally treated with CPAP for more than 4 hours at night.24-hour ambulatory blood pressure monitoring was conducted following 12 weeks of treatment,and the blood pressure rhythm was analyzed according to blood pressure results.Results A total of 104 patients(40-73 years old)were enrolled in the study,with 51 patients(mean age:57.3±9.1)in the CPAP group(58.8%male)and 53 patients(mean age:58.3±8.1)in the control group(54.7%male).The results of 24-hour ambulatory blood pressure monitoring showed that,compared with the control group,the CPAP group achieved more effective blood pressure reduction in mean systolic blood pressure(SBP)[(134.6±8.4)mmHg vs.(138.2±5.9)mmHg,t=-2.54,P=0.013],mean DBP[(72.4±9.3)mmHg vs.(77.0±9.0),t=-2.56,P=0.012],mean nighttime SBP[(117.2±5.1)mmHg vs.(122.0±6.2)mmHg,t=-4.283,P<0.01]and mean nighttime DBP[(63.7±6.4)mmHg vs.(66.9±5.1)mmHg,t=-2.812,P<0.01].There was a significant increase in blood pressure dippers in the CPAP group(37.25%vs.18.87%,χ^(2)=4.370,P=0.037).Conclusions CPAP can significantly reduce 24-hour mean blood pressure and nocturnal blood pressure,and improve blood pressure rhythm in hypertensive patients with sleep apnea syndrome.