A randomized controlled trial on ambulatory blood pressure lowering effect of CPAP in patients with obstructive sleep apnea and nocturnal hypertension
A randomized controlled trial on ambulatory blood pressure lowering effect of CPAP in patients with obstructive sleep apnea and nocturnal hypertension
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CPAP对阻塞性睡眠呼吸暂停和夜间高血压患者动态血压降低作用的随机对照试验
DOI：
10.1080/08037051.2019.1686343
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发表时间：
2019-11-06
期刊：
影响因子：
1.8
通讯作者：
Wang, Ji-Guang
中科院分区：
文献类型：
--
作者：
Chen, Qi;Cheng, Yi-Bang;Wang, Ji-Guang
摘要目的：在一项随机对照试验中，我们研究了持续气道正压通气（CPAP）对中重度阻塞性睡眠呼吸暂停综合征（OSAS，呼吸暂停低通气指数，AHI ≥ 15）和夜间高血压（夜间收缩压/舒张压≥120/70 mmHg）患者的降压作用。方法：60例患者随机分为CPAP组和假CPAP组，同时维持降压治疗。在基线（首次导入访视）和随访结束时进行动态血压监测。在基线和每月随访时测量门诊和家庭血压。结果：60例患者中，47例完成了3个月的研究。与假CPAP（n = 21）相比，CPAP（n = 26）使24小时收缩压/舒张压轻微且无显著性降低−2.8/−2.5 mmHg（p ≥ 0.27），日间组间差异（−4.0/−2.8 mmHg，p ≥ 0.29）略大于夜间组间差异（−0.2/−1.5 mmHg，p ≥ 0.50）。CPAP治疗对随访期间的门诊或家庭血压无显著影响（p ≥ 0.27）。尽管如此，简单和部分相关分析显示，动态血压降低效应依赖于基线时的日间脉率（r ≥ 0.47，p ≤ 0.01）。在日间脉率大于85次/分的患者中，CPAP组（n = 10）日间收缩压的平均变化显著大于假CPAP组（n = 11），组间平均差异为−10.1 mmHg（p = 0.048）。结论：CPAP治疗对中重度OSAS伴夜间高血压患者的动态血压无明显降低作用。然而，它可能是有效的，在白天降低血压的患者与更快的脉搏。
Abstract Objective: In a randomised controlled trial, we investigated the blood pressure (BP) lowering effect of continuous positive airway pressure (CPAP) in patients with moderate-severe obstructive sleep apnoea syndrome (OSAS, an apnoea-hypopnoea index, AHI of 15 or higher) and nocturnal hypertension (night-time systolic/diastolic BP ≥120/70 mmHg). Methods: Sixty patients were randomly assigned to CPAP or sham CPAP, while maintaining their antihypertensive treatment. Ambulatory BP monitoring was performed at baseline (first run-in visit) and the end of follow-up. Clinic and home BP were measured at baseline and each of the monthly follow-up visits. Results: Of the 60 patients, 47 completed the 3-month study. CPAP (n = 26), compared with sham CPAP (n = 21), slightly and non-significantly reduced 24-h systolic/diastolic BP by −2.8/−2.5 mmHg (p ≥ 0.27), with a slightly greater between-group difference in the daytime (−4.0/−2.8 mmHg, p ≥ 0.29) than night-time (−0.2/−1.5 mmHg, p ≥ 0.50). The CPAP treatment did not significantly influence clinic or home BP during follow-up (p ≥ 0.27). Nonetheless, simple and partial correlation analyses showed that the ambulatory BP lowering effect was dependent on the daytime pulse rate at baseline (r ≥ 0.47, p ≤ 0.01). In patients with a daytime pulse rate greater than 85 beats/min, the mean changes in daytime systolic BP were significantly greater in the CPAP (n = 10) than sham CPAP group (n = 11), with a between-group mean difference of −10.1 mmHg (p = 0.048). Conclusions: The CPAP treatment did not show significant ambulatory BP lowering effect in patients with moderate-severe OSAS and nocturnal hypertension. However, it may be effective in lowering daytime BP in patients with a faster pulse rate.