Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP.
Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP.
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DOI：
10.1016/j.sleep.2022.05.846
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发表时间：
2022-06
期刊：
影响因子：
4.8
通讯作者：
A. Pal;F. Martinez;R. Chatterjee;Ravi S. Aysola;R. Harper;V. Macefield;L. Henderson;P. Macey
中科院分区：
文献类型：
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作者：
A. Pal;F. Martinez;R. Chatterjee;Ravi S. Aysola;R. Harper;V. Macefield;L. Henderson;P. Macey
阻塞性睡眠呼吸暂停（OSA）增加交感血管收缩驱动，降低压力反射敏感性（BRS），血压变化改变心输出量的程度。夜间持续气道正压通气（CPAP）是否能纠正OSA患者清醒状态下的BRS尚不清楚。我们在未治疗的OSA（unOSA）、CPAP治疗的OSA（cpOSA）和健康（CON）参与者中，使用非侵入性连续BP和ECG记录在休息时和在握力和Valsalva挑战期间评估自发BRS，这些动作增加了血管收缩驱动力，血压逐渐升高。（年龄平均值±标准差，50.6± 14.1岁;呼吸事件指数[REI] 21.0±15.3次事件/小时; 22例男性），31例cpOSA（49.6± 14.5岁; REI 23.0±14.2次/小时; 22名男性;自我报告4+小时/夜，5+天/周，6个月）和39名对照组（42.2± 15.0岁; 17名男性），我们计算了静息、握柄和Valsalva时的BRS。此外，我们还将这些方案中的BP变异性（BPV）与BRS进行了相关性分析。（平均值±sdv，单位ms/mmHg），静息时：14.8±11.8，15.8±17.0，16.1±11.3;握柄期间：13.3±7.6，12.7±8.4，16.4±8.7; Valsalva期分别为12.7±8.0，11.5±6.6，15.1±8.9。对于手柄（p=0.04）和Valsalva（p=0.03），cpOSA中的BRS低于CON。非OSA患者在Valsalva期间的BRS与BPV呈负相关，cpOSA患者的BRS与BPV呈负相关，R均=-0.4（p=0.02）。BRS与OSA严重程度（无、轻度、中度、重度）呈负相关，R=-0.2（p= 0.04，n =104）。结论正如预期，在升压试验期间，OSA患者BRS较低，BPV较高，疾病严重程度与BRS呈负相关。在这项横断面研究中，CPAP治疗（自我报告）和未治疗的OSA均显示BRS降低，但人内CPAP是否改善BRS尚不清楚。
IntroductionObstructive sleep apnea (OSA) increases sympathetic vasoconstrictor drive and reduces baroreflex sensitivity (BRS), the degree to which blood pressure changes modify cardiac output. Whether nighttime continuous positive airway pressure (CPAP) corrects BRS in the awake state in OSA remains unclear. We assessed spontaneous BRS using non-invasive continuous BP and ECG recordings at rest and during handgrip and Valsalva challenges, maneuvers that increase vasoconstrictor drive with progressively higher BP, in untreated OSA (unOSA), CPAP-treated OSA (cpOSA) and healthy (CON) participants.MethodsIn a cross-sectional study of 104 participants, 34 unOSA (age mean±std, 50.6±14.1years; Respiratory Event Index [REI] 21.0±15.3 events/hour; 22male), 31 cpOSA (49.6±14.5years; REI 23.0±14.2 events/hour; 22male; self-report 4+hours/night,5+days/week,6months), and 39 CON (42.2±15.0years; 17male), we calculated BRS at rest and during handgrip and Valsalva. Additionally, we correlated BP variability (BPV) with BRS during these protocols.ResultsBRS in unOSA, cpOSA and CON was, respectively (mean±sdv in ms/mmHg), at rest: 14.8±11.8, 15.8±17.0, 16.1±11.3; during handgrip 13.3±7.6, 12.7±8.4, 16.4±8.7; and during Valsalva 12.7±8.0, 11.5±6.6, 15.1±8.9. BRS was lower in cpOSA than CON for handgrip (p=0.04) and Valsalva (p=0.03). BRS was negatively correlated with BPV in unOSA during Valsalva and handgrip for cpOSA, both R=−0.4 (p=0.02). BRS was negatively correlated with OSA severity (levels: none, mild, moderate, severe) at R=−0.2 (p=0.04,n=104).ConclusionsAs expected, BRS was lower and BPV higher in OSA during the pressor challenges, and disease severity negatively correlated with BRS. In this cross-sectional study, both CPAP-treated (self-reported) and untreated OSA showed reduced BRS, leaving open whether within-person CPAP improves BRS.