Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.
Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.
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气道正压通气可改善伴有阻塞性睡眠呼吸暂停的肥胖低通气综合征的夜间逐搏血压激增。
DOI：
10.1152/ajpregu.00516.2015
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Mokhlesi,Babak
中科院分区：
文献类型：
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作者：
Carter,JasonR;Fonkoue,IdaT;Grimaldi,Daniela;Emami,Leila;Gozal,David;Sullivan,ColinE;Mokhlesi,Babak
气道正压通气（PAP）治疗已被证明对阻塞性睡眠呼吸暂停（OSA）患者的动态血压（BP）有适度的影响。然而，关于PAP治疗对睡眠期间快速但显著的BP波动的影响的数据很少，特别是肥胖低通气综合征（OHS）。本研究假设，PAP治疗将改善OHS患者基础OSA的第一个治疗夜（滴定PAP）的夜间血压，并且这些改善将在PAP治疗6周后变得更加显著。17名OHS和临床诊断为OSA的成人（7名男性，10名女性;年龄50.4 ± 10.7岁，BMI 49.3 ± 2.4 kg/m2）参加了3次过夜实验室访视，包括多导睡眠图和通过手指体积描记法进行的逐搏BP监测。6周的PAP治疗，而不是滴定PAP，降低了平均夜间血压。相比之下，当夜间逐搏BP被聚集到由至少三个连续心动周期组成的箱中时，血压波动>10 mmHg（即，Δ10-20、Δ20-30、Δ30-40和Δ>40 mmHg）、滴定和6 wk PAP降低了每小时BP峰数（时间× bin，P< 0.05）。6周内PAP依从性与夜间收缩压（r= 0.713，P = 0.001）和舒张压（r= 0.497，P = 0.043）峰压降低显著相关。尽管PAP治疗可改善夜间逐搏血压升高，但6周PAP治疗并未改变日间血压。总之，PAP治疗减少了OHS合并基础OSA患者的夜间逐搏血压波动，PAP依从性高的患者夜间血压调节的改善更大。
Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m2) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10–20, Δ20–30, Δ30–40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin,P< 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r= 0.713,P= 0.001) and diastolic (r= 0.497,P= 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beat-to-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.