Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea
Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea
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DOI：
10.1161/01.cir.0000042706.47107.7a
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发表时间：
2003-01-07
期刊：
影响因子：
37.8
通讯作者：
Peter, JH
中科院分区：
文献类型：
--
作者：
Becker, HF;Jerrentrup, A;Peter, JH
背景-越来越多的证据表明阻塞性睡眠呼吸暂停（OSA）是动脉高血压的独立危险因素。由于没有对照研究显示经鼻持续气道正压通气（nCPAP）治疗对OSA高血压的实质性影响，因此治疗对心血管后遗症的影响一直受到质疑。因此，我们研究了nCPAP对动脉高血压患者的影响与OSA.Methods和Results-Sixty连续中度至重度OSA患者被随机分配到有效或亚治疗nCPAP平均9周。在治疗前和治疗期间进行夜间多导睡眠图和连续无创血压记录19小时。32名患者（每组16名）完成了研究。治疗组和亚治疗组的呼吸暂停和呼吸不足分别减少约95%和50%。有效的nCPAP治疗使平均动脉血压降低了9.9 ± 11.4 mm Hg，而亚治疗nCPAP没有发生相关变化（P = 0.01）。平均舒张压和收缩压均显著降低，约为10 mm Hg，无论是在夜间和day.Conclusions有效的nCPAP治疗中度至重度OSA患者导致白天和夜间动脉血压大幅降低。呼吸暂停低通气指数降低50%并没有导致血压降低，这一事实强调了高效治疗的重要性。平均血压下降10毫米汞柱预计将使冠心病事件风险降低37%，中风风险降低56%。
Background-There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA.Methods and Results-Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximate to95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean diastolic, and systolic blood pressures all decreased significantly by approximate to10 mm Hg, both at night and during the day.Conclusions-Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.