持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者降压效果的Meta分析  

Curative effect of continuous positive airway pressure on treatment of patients with obstructive sleep apnea hypopnea syndrome and hypertension:A Meta-analysis

作　　者：缪碧芳[1] 沈宁[2] 肖建宏[1] 彭锦芸[1] 曾林淼[1] 胡良平[2] 

机构地区：[1]福建医科大学附属闽东医院呼吸内科,福建福安355000 [2]军事医学科学院生物医学统计学咨询中心,北京100850

出　　处：《解放军医学杂志》2016年第11期925-935,共11页Medical Journal of Chinese People's Liberation Army

摘　　要：目的系统评价持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者的疗效。方法计算机检索Pub Med、Cochrane Library、中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)和万方数据库,搜集在常规降压药物基础上采用持续气道正压通气与单纯采用降压药物治疗OSAHS合并高血压疗效比较的随机对照研究(RCTs),检索时限均为建库至2015年10月。由两位研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入16个RCTs,包括2101例患者。Meta分析结果显示,在随访小于12周时,持续气道正压通气治疗组日间收缩压[MD=–12.60,95%CI(–17.68,–7.52),P<0.00001],夜间收缩压[MD=–21.90,95%CI(–25.94,–17.86),P<0.00001],夜间舒张压[MD=–11.90,95%CI(–15.44,–8.36),P<0.00001]降低程度明显大于对照组,但日间舒张压、24h平均收缩压、24h平均舒张压与对照组差异无统计学意义(P>0.05)。在随访大于等于12周时,持续气道正压通气治疗组24h平均收缩压[MD=–7.88,95%CI(–12.09,–3.66),P=0.00002]、24h平均舒张压[[MD=–5.14,95%CI(–6.00,–4.28),P<0.00001]、日间收缩压[MD=–5.89,95%CI(–8.79,–2.98),P<0.0001]、日间舒张压[MD=–4.34,95%CI(–6.32,–2.36),P<0.0001]、夜间收缩压[MD=–7.06,95%CI(–11.12,–2.99),P=0.0007]、夜间舒张压[MD=–4.49,95%CI(–7.39,–1.58),P=0.006]降低程度均明显大于对照组。结论在常规降压药物治疗的基础上采用持续气道正压通气治疗,可有效降低OSAHS合并高血压患者长期随访时的收缩压和舒张压,但短期随访时其降压效果不明显。受纳入研究质量限制,本研究结论尚需进一步开展多中心、大样本、高质量的随机对照双盲试验加以验证。Objective To systematically evaluate the curative effect of continuous positive airway pressure （CPAP） on treatment of patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and hypertension. Methods The data were retrieved of randomized controlled trials （RCTs） about the curative effect of CPAP on treatment of patients with OSAHS and hypertension from PubMed, Cochrane Library, CNKI, VIP, CBM and WanFang database from inception to Oct. 2015. Literature screening, data extraction and risk bias assessment were performed by two independent reviewers, and meta-analysis was then carried out by using RevMan 5.3 software. Results A total of 16 RCTs involving 2101 patients were included. Meta-analysis revealed that, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the daytime systolic pressure [MD=-12.60, 95%CI（-17.68 to -7.52）, P〈0.00001], nighttime systolic pressure [MD=-21.90, 95%CI（-25.94 to -17.86）, P〈0.00001] and nighttime diastolic pressure IMD=-11.90, 95%CI（-15.44 to -8.36）, P〈0.00001], while created no significant difference in daytime diastolic pressure, 24-h mean systolic pressure and 24-h mean diastolic pressure in a following- up less than 12 weeks. Whereas in the following-up no less than 12 weeks, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the 24-h mean systolic pressure [MD=-7.88, 95%CI（-12.09 to -3.66）, P=0.00002], 24-h mean diastolic pressure [MD=-S.14, 95%CI（-6.00 to -4.28）, P〈0.00001], daytime systolic pressure [MD=-5.89, 95%CI（-8.79 to -2.98）, P〈0.0001~, daytime diastolic pressure [MD=-4.34, 95%CI（-6.32 to -2.36）, P〈0.0001]; nighttime systolic pressure IMD=-7.06, 95%CI（-11.12 to -2.99）, P=0.0007] and nighttime diastolic pressure [MD=-4.49, 95%CI （-7.39 to -1.58）, P=0.006]. Conclusions The current evidences suggest that on the basis of antihypertensive drug therapy, CPAP may effectively reduce

关 键 词：睡眠呼吸暂停 阻塞性 高血压 连续气道正压通气 META分析 随机对照试验 

分 类 号：R767.13[医药卫生—耳鼻咽喉科]