Resistant hypertension and obstructive sleep apnea in the setting of kidney disease.
Resistant hypertension and obstructive sleep apnea in the setting of kidney disease.
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DOI：
10.1097/hjh.0b013e328351d08a
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发表时间：
2012-05
影响因子：
4.9
通讯作者：
Unruh ML
中科院分区：
文献类型：
--
作者：
Abdel-Kader K;Dohar S;Shah N;Jhamb M;Reis SE;Strollo P;Buysse D;Unruh ML
目的探讨慢性肾脏病(CKD)和终末期肾病(ESRD)患者阻塞性睡眠呼吸暂停(OSA)与顽固性高血压的关系。我们检测了来自睡眠评分研究的224名社区非CKD参与者、88名非透析依赖的CKD参与者和95名ESRD参与者的睡眠参数和血压(BP)。使用了无人值守的家庭多导睡眠图和标准化的评分方案和自动血压监测仪。难治性高血压被定义为BP≥140/90毫米汞柱，尽管有≥3降压药。尽管使用了更多的抗高血压药物，慢性肾脏病组和终末期肾病组的平均收缩压仍显著高于非慢性肾脏病组(分别为148.2 mm Hg[23.8]，144.5 mm Hg[26.7]vs 132.2 mm Hg[26.7]；P<；0.0001)。慢性肾脏病组和终末期肾病组的顽固性高血压患病率分别为41.4%、22.6%，高于非慢性肾脏病组的6.7%(P<；0.0001)。睡眠呼吸暂停的严重程度与顽固性高血压的风险较高相关。在患有终末期肾病的患者中，顽固性高血压与严重的睡眠呼吸暂停有关(优势比[OR]7.1，95%可信区间[CI]2.2-23.2)，但在非CKD组(OR 3.5，95%CI 0.8-15.4)或CKD组(OR 1.2，95%CI 0.4-3.7)中没有显著关联。在ESRD患者中，顽固性高血压和睡眠呼吸暂停之间的相关性很强。OSA可能导致顽固性高血压，或者两者都可能与共同的潜在过程有关，如容量过剩。未来对肾病患者的研究应进一步确定抵抗高血压与阻塞性睡眠呼吸暂停综合征的关系，并确定潜在机制的治疗是否可以改善结果。
To explore the relationship between obstructive sleep apnea (OSA) and resistant hypertension in chronic kidney disease (CKD) and end-stage renal disease (ESRD). We examined sleep parameters and blood pressure (BP) in 224 community-based, non-CKD participants from the Sleep-SCORE study, 88 non-dialysis dependent CKD and 95 ESRD participants. Unattended home polysomnography with standardized scoring protocols and automated BP monitors were used. Resistant hypertension was defined as a BP ≥ 140/90 mmHg despite ≥ 3 antihypertensives. Mean systolic BP of the CKD and ESRD groups were significantly higher than the non-CKD group (148.2mmHg [23.8], 144.5mmHg [26.7] vs. 132.2mmHg [26.7], respectively; P<0.0001) despite the use of more anti-hypertensive medications. The CKD and ESRD groups had higher rates of resistant hypertension than the non-CKD group (41.4%, 22.6% vs. 6.7%, respectively; P<0.0001). The severity of sleep apnea was associated with a higher risk of resistant hypertension. While resistant hypertension was associated with severe sleep apnea in participants with ESRD (odds ratio [OR] 7.1, 95% confidence interval [CI] 2.2-23.2), there was no significant association in the non-CKD (OR 3.5, 95% CI 0.8-15.4) or CKD groups (OR 1.2, 95% CI 0.4-3.7) after accounting for case-mix. The association between resistant hypertension and sleep apnea appeared robust in ESRD. OSA may contribute to resistant hypertension or both may be linked to a common underlying process such as volume excess. Future studies in patients with kidney disease should further characterize the resistant hypertension - OSA relationship and determine whether treatment of underlying mechanisms may improve outcomes.