持续正压通气对阻塞性睡眠呼吸暂停合并难治性高血压患者血压水平的影响  

Effects of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea hypopnea syndrome and resistant hypertension

作　　者：宗敏[1] 李强[1] 马桂伶[1] 魏妤[1] 张建军[1] 杨新春[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心内科,北京100043

出　　处：《临床心血管病杂志》2016年第5期492-496,共5页Journal of Clinical Cardiology

基　　金：北京市自然科学基金(No:7142062)

摘　　要：目的:探讨持续正压通气(CPAP)对阻塞性睡眠呼吸暂停(OSAHS)合并难治性高血压(RH)患者血压的影响。方法:RH合并中重度OSAHS(呼吸暂停低通气指数≥15次/h)患者162例,根据是否自愿接受CPAP分为CPAP组(药物治疗基础上接受12周CPAP,88例,剔除3例不耐受和1例调整药物者)和非CPAP组(仅接受药物治疗,74例,剔除2例调整药物者)。治疗前和治疗12周后行24h动态血压,测清晨卧位血浆肾素-血管紧张素-醛固酮水平。结果:治疗12周后,与非CPAP组比较,CPAP组24h收缩压[(-4.9±5.1)mmHg︰(-0.8±1.2)mmHg]、24h舒张压[(-5.9±5.3)mmHg︰(-1.4±1.7)mmHg]、白昼收缩压[(-4.9±5.2)mmHg︰(-2.1±2.5)mmHg]、白昼舒张压[(-5.1±4.2)mmHg︰(-1.7±1.4)mmHg]以及夜间收缩压[(-4.8±4.9)mmHg︰(0.8±1.3)mmHg]、夜间舒张压[(-6.8±5.6)mmHg︰(-1.0±1.6)mmHg]的血压变化值降低幅度更大(均P<0.05);治疗12周后,CPAP组24h舒张压变异性[(11.4±5.6)︰(14.6±6.4)]、白昼舒张压变异性[(9.5±4.5)︰(11.8±6.2)]以及夜间舒张压变异性[(8.0±4.3)︰(10.9±5.6)]明显降低,且低于非CPAP组(均P<0.05)。结论:中重度OSAHS合并RH患者中,药物治疗基础上12周CPAP能够明显降低24h、白昼及夜间收缩压与舒张压水平,并可使舒张压变异性降低。Objective：To explore the effects of continuous positive airway pressure（CPAP）treatment on blood pressure values in patients with resistant hypertension（RH）and obstructive sleep apnea hypopnea syndrome（OSAHS）.Method：A total of 162 patients with the apnea-hypopnea index at least 15events/h were recruited.According to the patients＇ acceptance to CPAP,data of 84 patients received 12 weeks CPAP treatment（CPAP group）and 74 patients received conventional medical treatment alone（control group）were analyzed.Before and after 12 weeks of treatment,24 hambulatory blood pressure monitoring（ABPM）was performed and early morning reninangiotensin-aldosterone levels were determined.Result：Compared with the control group,CPAP showed a significant decrease in 24hsystolic/diastolic ABPM [（-0.8±1.2）/（-1.4±1.7）mmHg vs（-4.9±5.1）/（-5.9±5.3）mmHg,respectively,P〈0.05],awake systolic/diastolic ABPM [（-2.1±2.5）/（-1.7±1.4）mmHg vs（-4.9±5.2/-5.1±4.2）mmHg,respectively,P〈0.05）],and nocturnal ABPM [（0.8±1.3）/（-1.0±1.6）mmHg vs（-4.8±4.9）/（-6.8±5.6）mmHg,respectively,P〈0.05）].On 12 weeks,diastolic blood pressure variability（BPV）decreased significantly compared with before treatment.Conclusion：On the basis of conventional medical treatment,CPAP may significantly decrease the 24 h,awake and nocturnal systolic and diastolic ABPM in moderate to severe OSAHS and RH patients,and might further influence the diastolic blood pressure variability.

关 键 词：高血压 睡眠呼吸暂停综合征 持续正压通气 血压 

分 类 号：R544.1[医药卫生—心血管疾病]