Association between treated and untreated obstructive sleep apnea and risk of hypertension.
Association between treated and untreated obstructive sleep apnea and risk of hypertension.
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DOI：
10.1001/jama.2012.3418
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发表时间：
2012-05-23
期刊：
影响因子：
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通讯作者：
Jelic S
中科院分区：
文献类型：
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作者：
Marin JM;Agusti A;Villar I;Forner M;Nieto D;Carrizo SJ;Barbé F;Vicente E;Wei Y;Nieto FJ;Jelic S
阻塞性睡眠呼吸暂停（OSA）患者普遍存在全身性高血压。短期研究表明，持续气道正压通气（CPAP）治疗可降低高血压和OSA患者的血压。确定CPAP治疗是否与降低高血压发病风险相关。一项前瞻性队列研究，纳入了1889名无高血压的参与者，这些参与者于1994年1月1日至2000年12月31日期间被转诊至西班牙萨拉戈萨的睡眠中心进行夜间多导睡眠描记。在2011年1月1日之前的年度随访访视中记录高血压事件。调整混杂因素的多变量模型，包括从基线到删失时间的体重指数变化，用于计算无OSA（对照组）、未治疗OSA和根据国家指南接受CPAP治疗的参与者中高血压事件的风险比（HR）。新发高血压的发病率。在21003人-年的随访（中位数，12.2年）中，观察到705例（37.3%）高血压事件。按每百人年计算的高血压粗发病率为2.19（95% CI，1.71-2.67）对照组，3.34（95% CI，2.85-3.82）不适合CPAP治疗的OSA患者，5.84（95% CI，4.82-6.86）在拒绝CPAP治疗的OSA患者中，5.12 CPAP治疗不依从的OSA患者的平均生存时间为3.76-6.47（95% CI，3.76-6.47），CPAP治疗的OSA患者的平均生存时间为3.06（95% CI，2.70-3.41）。与对照组相比，不适合CPAP治疗的OSA患者的高血压事件校正HR更高（1.33; 95% CI，1.01-1.75），在拒绝CPAP治疗的患者中（1.96; 95%CI，1.44-2.66），在不依从CPAP治疗的患者中，（1.78; 95%CI，1.23-2.58），而接受CPAP治疗的OSA患者HR较低（0.71; 95%CI，0.53-0.94）。与无OSA的受试者相比，OSA的存在与高血压事件的校正风险增加相关;然而，CPAP治疗与高血压风险降低相关。
Systemic hypertension is prevalent among patients with obstructive sleep apnea (OSA). Short-term studies indicate that continuous positive airway pressure (CPAP) therapy reduces blood pressure in patients with hypertension and OSA. To determine whether CPAP therapy is associated with a lower risk of incident hypertension. A prospective cohort study of 1889 participants without hypertension who were referred to a sleep center in Zaragoza, Spain, for nocturnal polysomnography between January 1, 1994, and December 31, 2000. Incident hypertension was documented at annual follow-up visits up to January 1, 2011. Multivariable models adjusted for confounding factors, including change in body mass index from baseline to censored time, were used to calculate hazard ratios (HRs) of incident hypertension in participants without OSA (controls), with untreated OSA, and in those treated with CPAP therapy according to national guidelines. Incidence of new-onset hypertension. During 21 003 person-years of follow-up (median, 12.2 years), 705 cases (37.3%) of incident hypertension were observed. The crude incidence of hypertension per 100 person-years was 2.19 (95% CI, 1.71–2.67) in controls, 3.34 (95% CI, 2.85–3.82) in patients with OSA ineligible for CPAP therapy, 5.84 (95% CI, 4.82–6.86) in patients with OSA who declined CPAP therapy, 5.12 (95% CI, 3.76–6.47) in patients with OSA nonadherent to CPAP therapy, and 3.06 (95% CI, 2.70–3.41) in patients with OSA and treated with CPAP therapy. Compared with controls, the adjusted HRs for incident hypertension were greater among patients with OSA ineligible for CPAP therapy (1.33; 95% CI, 1.01–1.75), among those who declined CPAP therapy (1.96; 95% CI, 1.44–2.66), and among those nonadherent to CPAP therapy (1.78; 95% CI, 1.23–2.58), whereas the HR was lower in patients with OSA who were treated with CPAP therapy (0.71; 95% CI, 0.53–0.94). Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension.