Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome
Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome
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DOI：
10.1152/ajpendo.00780.2007
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发表时间：
2008-08-01
影响因子：
5.1
通讯作者：
Zanella, Maria Teresa
中科院分区：
文献类型：
--
作者：
Carneiro, Glaucia;Togeiro, Sonia Maria;Zanella, Maria Teresa
阻塞性睡眠呼吸暂停综合征（OSAS）会增加心血管事件的风险。交感神经系统和下丘脑-垂体-肾上腺（HPA）轴的激活可能是这种关系的机制。本研究的目的是评估HPA轴和动态血压监测肥胖男性和OSAS，以确定是否鼻持续气道正压通气治疗（nCPAP）的影响反应。对16例肥胖男性OSAS患者和13例肥胖男性对照者进行24小时动态血压监测和0.25 mg地塞米松过夜皮质醇抑制试验。9名严重呼吸暂停的男性在nCPAP治疗后3个月重新评估。OSAS患者和肥胖对照组的体重指数和血压相似。与肥胖对照组相比，OSAS患者夜间收缩压下降率（P = 0.027）和地塞米松治疗后唾液皮质醇抑制率（P = 0.038）较低，而心率（P = 0.022）较高。nCPAP治疗后，患者心率降低（P = 0.036），地塞米松治疗后皮质醇抑制更大（P = 0.001）。nCPAP治疗3个月后，未观察到动脉血压差异（P = 0.183）。皮质醇抑制的改善与nCPAP治疗期间呼吸暂停低通气指数的改善呈正相关（r = 0.799，P = 0.010）。总之，患有OSAS的男性存在增加的地塞米松后皮质醇水平和心率，这通过nCPAP恢复。
Obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular events. Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. The aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. In OSAS patients, the percentage of fall in systolic blood pressure at night (P = 0.027) and salivary cortisol suppression postdexamethasone (P = 0.038) were lower, whereas heart rate (P = 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P = 0.036) and a greater cortisol suppression after dexamethasone (P = 0.001). No difference in arterial blood pressure (P = 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r = 0.799, P = 0.010). In conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP.