CPAP对高血压伴代谢综合征的OSAS患者的影响  

CPAP Effects on Hypertensive Metabolic Syndrome Patients with OSAS

作　　者：孙宇[1] 李翠萍[1] 翟云清[1] 李朝辉[1] 陈雪松[1] 仇立平[1] 

机构地区：[1]山东省滨州市中心医院,251700

出　　处：《中国分子心脏病学杂志》2012年第4期217-221,共5页Molecular Cardiology of China

基　　金：山东省医药卫生科技发展计划资助项目(2011WSA16015)

摘　　要：目的探讨持续气道正压通气(Continuous positive airway pressure,CPAP)干预对有阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome,OSAS)的高血压伴代谢综合征患者的血压及异常代谢组分的影响。方法采用双盲、安慰剂对照设计,将患者随机分配接受5个月CPAP治疗或者5个月假性CPAP。在每种干预之前和之后,检测受试者的血压、空腹血糖、胰岛素抵抗指数、空腹血脂谱、糖化血红蛋白及人体测量学参数等指标。结果共128例完成研究。CPAP治疗与下列指标平均值的显著降低相关:收缩压(6.1mmHg;95%可信区间[CI]:1.3～6.2,P=0.001),舒张压(4.5mmHg;95%CI:0.8～4.2,P<0.001),血清总胆固醇(16.5mg/dl;95%CI:5.2～21.4,P=0.005),非高密度脂蛋白胆固醇(16.1mg/dl;95%CI:4.7～21.9,P=0.008),低密度脂蛋白胆固醇(12.8mg/dl;95%CI:2.4～16.9,P=0.007),甘油三酯(21.9mg/dl;95%CI:4.2～42.1,P=0.03)和糖化血红蛋白(0.4%;95%CI:0.1～0.5,P=0.004)。CPAP治疗后代谢综合征显著好转(128例患者中23例逆转[18%]vs.假性CPAP治疗后仅3例逆转[2%])。结论在有中重度OSAS的高血压伴代谢综合征患者中,CPAP治疗5个月可降低血压并改善伴随的代谢异常。Objective To study the clinical effects of continuous positive airway pressure （CPAP） on hypertensive metabolic syndrome pa- tients with obstructive sleep apnea syndrome. Methods In our double-blind, controlled trial, we randomly assigned patients with obstructive sleep apnea syndrome to undergo 5 months of therapeutic CPAP or 5 months of sham CPAP, we obtained measurements of anthropometrie variables, blood pressure, fasting blood glucose levels, insulin resistance etc. Results A total of 128 patients completed the study .CPAP treatment （vs. sham CPAP） was associated with significant mean decreases in systolic blood pressure （3.9 mm Hg; 95% confidence interval [CI], 1.4 to 6.4; P = 0.001）, diastolic blood pressure （4.5 mm Hg; 95% CI, 0.8 to 4.2; P 〈 0.001）, serum total cholesterol （16.5 mg per deciliter; 95% CI, 5.2 to 21.4; P = 0.005）, non-high- density lipoprotein cholesterol （16.1 mg per deciliter; 95% CI, 4.7 to 21.9; P = 0.008）,low-density lipoprotein cholesterol （12.8 mg per deciliter; 95% CI, 2.9 to 16.9; P = 0.007）, triglycerides （21.9 mg per deciliter; 95% CI, 4.2 to 42.1; P = 0.03）, and glycated hemoglobin （0.4%; 95% CI, 0.1 to 0.5; P = 0.004）. The frequency of the metabolic syndrome was reduced after CPAP therapy （reversal found in 23 of 128 patients [18%] undergoing CPAP therapy vs. 3 [2%] undergoing sham CPAP）. Conclusions In patients with moderate-to-severe obstructive sleep apnea syndrome, 5 months of CPAP therapy lowers blood pressure and partially reverses metabolic abnormalities.

关 键 词：持续气道正压通气 高血压 代谢综合征 

分 类 号：R589[医药卫生—内分泌]