CPAP versus oxygen in obstructive sleep apnea.
CPAP versus oxygen in obstructive sleep apnea.
复制标题
DOI：
10.1056/nejmoa1306766
复制
发表时间：
2014-06-12
期刊：
影响因子：
--
通讯作者：
Redline S
中科院分区：
文献类型：
--
作者：
Gottlieb DJ;Punjabi NM;Mehra R;Patel SR;Quan SF;Babineau DC;Tracy RP;Rueschman M;Blumenthal RS;Lewis EF;Bhatt DL;Redline S
阻塞性睡眠呼吸暂停与高血压、炎症和心血管风险增加有关。持续气道正压通气（CPAP）可降低血压，但依从性通常不理想，并且超出常规风险因素管理的益处不确定。由于间歇性低氧血症可能是睡眠呼吸暂停的心血管后遗症的基础，我们评估了夜间补充供氧和CPAP对心血管风险标志物的影响。我们进行了一项随机对照试验，其中心血管疾病或多种心血管危险因素的患者从心脏病学实践中招募。使用柏林问卷对患者进行阻塞性睡眠呼吸暂停筛查，并使用家庭睡眠测试来确定诊断。呼吸暂停低通气指数为15 - 50次/小时的参与者被随机分配接受单独的睡眠卫生和健康生活方式教育（对照组），或者除了教育之外，还接受CPAP或夜间补充供氧。在基线和研究治疗12周后评估心血管风险。主要结局是24小时平均动脉压。在接受随机分组的318例患者中，281例（88%）可在基线和随访时评价动态血压。平均而言，CPAP组12周时的24小时平均动脉压低于对照组（−2.4 mm Hg; 95%置信区间[CI]，−4.7至−0.1; P = 0.04）或辅助供氧组（−2.8 mm Hg; 95% CI，−5.1至−0.5; P = 0.02）。对照组和吸氧组的24小时平均动脉压无显著差异。使用多重插补方法进行敏感性分析以评估缺失数据的影响，未改变主要分析的结果。在有心血管疾病或多种心血管危险因素的患者中，使用CPAP治疗阻塞性睡眠呼吸暂停，而不是夜间补充氧气，导致血压显著降低。（由国家心肺血液研究所和其他机构资助; HeartBEAT ClinicalTrials.gov编号，NCT 01086800。
Obstructive sleep apnea is associated with hypertension, inflammation, and increased cardiovascular risk. Continuous positive airway pressure (CPAP) reduces blood pressure, but adherence is often suboptimal, and the benefit beyond management of conventional risk factors is uncertain. Since intermittent hypoxemia may underlie cardiovascular sequelae of sleep apnea, we evaluated the effects of nocturnal supplemental oxygen and CPAP on markers of cardiovascular risk. We conducted a randomized, controlled trial in which patients with cardiovascular disease or multiple cardiovascular risk factors were recruited from cardiology practices. Patients were screened for obstructive sleep apnea with the use of the Berlin questionnaire, and home sleep testing was used to establish the diagnosis. Participants with an apnea–hypopnea index of 15 to 50 events per hour were randomly assigned to receive education on sleep hygiene and healthy lifestyle alone (the control group) or, in addition to education, either CPAP or nocturnal supplemental oxygen. Cardiovascular risk was assessed at baseline and after 12 weeks of the study treatment. The primary outcome was 24-hour mean arterial pressure. Of 318 patients who underwent randomization, 281 (88%) could be evaluated for ambulatory blood pressure at both baseline and follow-up. On average, the 24-hour mean arterial pressure at 12 weeks was lower in the group receiving CPAP than in the control group (−2.4 mm Hg; 95% confidence interval [CI], −4.7 to −0.1; P = 0.04) or the group receiving supplemental oxygen (−2.8 mm Hg; 95% CI, −5.1 to −0.5; P = 0.02). There was no significant difference in the 24-hour mean arterial pressure between the control group and the group receiving oxygen. A sensitivity analysis performed with the use of multiple imputation approaches to assess the effect of missing data did not change the results of the primary analysis. In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure. (Funded by the National Heart, Lung, and Blood Institute and others; HeartBEAT ClinicalTrials.gov number, NCT01086800.)