持续正压通气治疗OSAS患者的24小时血压变化

Effect of Continuous Positive Airway Pressure Therapy on 24-Hour Blood Pressure in Patients with Obstructive Sleep Apnea Syndrome

目的 :了解鼻持续正压通气 (nCPAP)治疗阻塞性睡眠呼吸暂停综合征 (OSAS)患者的 2 4h动态血压变化情况。方法 :10 3例因打鼾就诊 ,进行多导睡眠监测的同时 ,随机进行 2 4h动态血压的监测。根据睡眠呼吸暂停 低通气指数 (AHI) ,分单纯打鼾组 (AHI≤ 2 0 ) 2 5例 ;OSAS组 (AHI >2 0 ) 78例。其中 78例OSAS组中 2 8例进行持续正压通气治疗 6个月后 ,进行 2 4h动态血压监测。结果 :( 1)OSAS组平均动脉血压明显高于单纯打鼾组 ,两组相比有明显的差异性 ( 12 1.1± 15 .7mmHg ,90 .2± 10 .3mmHg ,P<0 .0 1)。( 2 )多元逐步回归分析表明 :OSAS患者的血压变化与AHI有明显的正相关 (r =0 .5 2 ,P<0 .0 1) ,与年龄、吸烟、体重指数无关。 ( 3 ) 78例OSAS组中2 8例进行持续正压通气治疗 6个月后 ,平均动脉血压明显下降 (从 13 5 .6± 12 .3mmHg降到 10 0 .2± 10 .1mmHg ,P <0 .0 5 )。白天平均心率、2 4h脉压恢复正常。结论 :CPAP治疗OSAS是使血压降低最有效的方法 ,但并不是全部OSAS合并高血压的患者都有效。在CPAP治疗过程中 ,如出现心率和脉压的改善 。

Objective: To study the effect of continuous postive airway pressure (CPAP) theapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. Methods:Automated ambulatory 24h blood pressure monitoring was performed in 103 consecutive patients who were referred for evaluation of snoring underwent overnight polysomnoraphy. According to apnea/hypnea index(AHI), one grade was snoring (AHI≤20,n=25); the other was OSAS (AHI>20,n=78). Of 78 patient with OSAS, 28 patient treating with CPAP reevaluated after 6 months. Results:(1) Patient with OSAS had significantly higher mean arterial blood pressure (Bp) values than snorers (121.1±15.7 mmHg, 90.2±10.3 mmHg, P<0.01).(2) Multiple stepwise linear regression analysis disclosed that the degree of Bp was independently associated with the severity of OSAS as determined by AHI (r=0.52,P<0.01). But not with age,body mass index,or smoking habits. (3) Of the 78 patients with OSAS, 28 were treated with CPAP and reevaluated after 6 months. The CPAP resulted in a significant decrease in mean arterial Bp (from 135.6±12.3 mmHg to 100.2±10.1 mmHg, P<0.05), 24 h mean pulse pressure as well as average heart rate during the day turned out to be normal. Conclusion:CPAP therapy has a significant Bp lowering effect in most but not all hypertensive patients with OSAS. Baseline heart rate and pulse pressure may be predictors of a beneficial effect of CPAP therapy on Bp.