Pulmonary hypertension in obstructive sleep apnoea:: effects of continuous positive airway pressure -: A randomized, controlled cross-over study
Pulmonary hypertension in obstructive sleep apnoea:: effects of continuous positive airway pressure -: A randomized, controlled cross-over study
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DOI：
10.1093/eurheartj/ehi807
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发表时间：
2006-05-01
影响因子：
39.3
通讯作者：
Villamor, J
中科院分区：
文献类型：
--
作者：
Arias, MA;García-Río, F;Villamor, J
目的：我们验证了以下假设：（i）阻塞性睡眠呼吸暂停（OSA）本身起源于肺动脉高压（PH）;持续气道正压通气（CPAP）的应用可降低肺动脉压。方法和结果在这项随机交叉试验中，23例中年OSA患者，（呼吸暂停-低通气指数，44.1 +/- 29.3 h（-1））和其他健康患者以及10名对照受试者。OSA患者随机接受假CPAP或有效CPAP治疗12周。超声心动图参数，血压记录，尿儿茶酚胺水平在基线和两种治疗方式后获得。在基线时，OSA患者的肺动脉收缩压高于对照组（分别为29.8 ± 8.8和23.4 ± 4.1 mmHg，P=0.036）。23例患者中有10例[43%，（95% CI：23-64%）]和对照受试者中无受试者在基线时患有PH（P=0.012）。两名患者因CPAP依从性不足而退出研究。有效的CPAP可显著降低肺动脉收缩压（从28.9 ± 8.6 mmHg降至24.0 ± 5.8 mmHg，P < 0.0001）。无论是PH或左心室舒张功能不全的患者在basel.Conclusion严重OSA是独立与PH直接关系的疾病严重程度和舒张功能不全的存在。应用CPAP可降低肺动脉收缩压水平。
Aims We tested the hypothesis that: (i) obstructive sleep apnoea (OSA) by itself originates pulmonary hypertension (PH); and (ii) the application of continuous positive airway pressure (CPAP) can reduce pulmonary pressure.Methods and results In this randomized and cross-over trial, 23 middle-aged OSA (apnoea-hypopnoea index, 44.1 +/- 29.3 h(-1)) and otherwise healthy patients and 10 control subjects were included. OSA patients randomly received either sham or effective CPAP for 12 weeks. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, OSA patients had higher pulmonary artery systolic pressure than control subjects (29.8 +/- 8.8 vs. 23.4 +/- 4.1 mmHg, respectively, P=0.036). Ten out of 23 patients [43%, (95% CI: 23-64%)] and none of the control subjects had PH at baseline (P=0.012). Two patients were removed from the study because of inadequate CPAP compliance. Effective CPAP induced a significant reduction in the values for pulmonary systolic pressure (from 28.9 +/- 8.6 to 24.0 +/- 5.8 mmHg, P < 0.0001). The reduction was greatest in patients with either PH or left ventricular diastolic dysfunction at baseline.Conclusion Severe OSA is independently associated with PH in direct relationship with disease severity and presence of diastolic dysfunction. Application of CPAP reduces pulmonary systolic pressure levels.