Effects of continuous positive airway pressure on very short-term blood pressure variability associated with sleep-disordered breathing by pulse transit time-based blood pressure measurements
Effects of continuous positive airway pressure on very short-term blood pressure variability associated with sleep-disordered breathing by pulse transit time-based blood pressure measurements
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DOI：
10.1097/hjh.0000000000003395
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发表时间：
2023-05-01
影响因子：
4.9
通讯作者：
Takeishi，Yasuchika
中科院分区：
文献类型：
--
作者：
Misaka，Tomofumi;Yoshihisa，Akiomi;Takeishi，Yasuchika
背景：血压（BP）变异性（BPV）是独立于BP绝对值的心血管预后的预测因子。我们之前报道过脉冲传递时间（PTT）可以监测心跳间的血压，确定极短期BPV的程度与睡眠呼吸障碍（SDB）的严重程度之间的密切关系。在这里，我们研究了持续气道正压通气（CPAP）对极短期BPV的影响。方法：对66例新诊断为SDB的患者（平均年龄62岁，男性73%）进行连续2天的完整多导睡眠图诊断（基线）和CPAP，并连续记录ptt驱动的血压。PTT指数定义为30s /h内急性一过性血压升高（≥12 mmHg）的平均次数。结果：CPAP治疗可有效改善SDB参数，降低夜间ptt BP绝对值。CPAP治疗显著降低了包括PTT指数和收缩期PTT- bp标准偏差（SD）的极短期BPV。PTT指数从基线到CPAP的变化与呼吸暂停低通气指数、阻塞性呼吸暂停指数（OAI）、氧去饱和指数、最小SpO 2和平均SpO 2的变化呈正相关。多因素回归分析显示，OAI和最小SpO 2的变化以及心力衰竭是决定CPAP后PTT指数降低的独立因素。结论：ptt驱动的血压监测发现CPAP对SDB事件相关的极短期BPV有良好的影响。针对短期BPV可能是识别从CPAP中获益更大的个体的新方法。
Background:Blood pressure (BP) variability (BPV) is a predictor of cardiovascular outcomes independently of BP absolute values. We previously reported that pulse transit time (PTT) enables monitoring beat-to-beat BP, identifying a strong relationship between the extent of very short-term BPV and the severity of sleep-disordered breathing (SDB). Here, we investigated the effects of continuous positive airway pressure (CPAP) on very short-term BPV.Methods:We studied 66 patients (mean age 62 years old, 73% male) with newly diagnosed SDB who underwent full polysomnography on two consecutive days for diagnosis (baseline) and CPAP, together with PTT-driven BP continuous recording. PTT index was defined as the average number of acute transient rises in BP (≥ 12 mmHg) within 30 s/h.Results:CPAP treatment effectively improved SDB parameters, and attenuated PTT-based BP absolute values during the night-time. Very short-term BPV that includes PTT index and standard deviation (SD) of systolic PTT-BP was significantly reduced by CPAP therapy. The changes in PTT index from baseline to CPAP were positively correlated with the changes in apnea-hypopnea index, obstructive apnea index (OAI), oxygen desaturation index, minimal SpO 2, and mean SpO 2. Multivariate regression analysis revealed that changes in OAI and minimal SpO 2, as well as heart failure, were the independent factors in determining the reduction of PTT index following CPAP.Conclusion:PTT-driven BP monitoring discovered the favorable effects of CPAP on very short-term BPV associated with SDB events. Targeting very short-term BPV may be a novel approach to identifying individuals who experience greater benefits from CPAP.