持续气道正压通气整夜人工压力滴定对OSA合并高血压患者即时降压疗效及相关因素分析  

Analysis of the immediate antihypertensive efficacy and related factors of overnight manual pressure titration of continuous positive airway pressure ventilation in patients with obstructive sleep apnea complicated with hypertension

作　　者：冯智博 汪亚坤[1] 王菡侨[1] 周姗姗 雷倩 Feng Zhibo;Wang Yakun;Wang Hanqiao;Zhou Shanshan;Lei Qian(Department of Sleep Medicine,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院呼吸睡眠科,石家庄050051

出　　处：《中华医学杂志》2025年第14期1075-1080,共6页National Medical Journal of China

基　　金：河北省自然科学基金(H2020206318);河北省卫生厅科研基金(20160601)。

摘　　要：目的分析持续气道正压通气(CPAP)整夜人工压力滴定(OMPT)对阻塞性睡眠呼吸暂停(OSA)合并高血压患者即时降压疗效及相关因素。方法回顾性纳入88例河北医科大学第三医院2022年9月至2023年10月因夜间睡眠打鼾、憋气入院诊断为OSA合并高血压的患者。进行多导睡眠监测(PSG)下CPAP OMPT治疗,根据CPAP OMPT治疗后即时降压疗效(治疗前后15 min内血压变化情况)分为降压显著组[A组,收缩压(SBP)降低≥5 mmHg(1 mmHg=0.133 kPa)且舒张压(DBP)降低≥3 mmHg]和不显著组(N组,SBP降低<5 mmHg或DBP降低<3 mmHg)。比较两组人口学特征以及呼吸暂停低通气指数(AHI)、睡眠期脉搏血氧饱和度(SpO_(2))<90%的时间[T(SpO_(2)<90%)]、血氧饱和度下降指数(ODI)、睡眠期最低SpO_(2)(LSpO_(2))、睡眠期平均SpO_(2)(MSpO_(2))的差异,采用多因素logistic回归模型分析CPAP OMPT改善血压的相关因素。结果88例OSA合并高血压患者中,男77例,女11例,年龄(46.5±13.2)岁。A组33例,N组55例,即CPAP OMPT对37.5%的OSA合并高血压患者即时降压疗效显著;两组年龄、性别构成、颈围、糖尿病史、冠心病史、高脂血症病史差异均无统计学意义(均P>0.05)。经CPAP OMPT治疗后,A组LSpO_(2)及MSpO_(2)变化值[M(Q 1,Q 3)]均高于N组[17.0%(9.0%,22.0%)比8.0%(5.0%,15.0%),4.0%(1.0%,7.0%)比2.0%(1.0%,4.0%),均P<0.05];A组AHI、ODI及T(SpO_(2)<90%)变化值均低于N组[(-59.9±26.2)比(-43.7±25.3)次/h,-52.7(-64.1,-31.0)比-32.0(-54.0,-12.8)次/h,-75.8(-148.6,-9.8)比-12(-82.9,-2.6)min,均P<0.05]。多因素logistic回归模型分析结果提示,LSpO_(2)变化值与CPAP OMPT改善血压呈正向关联,OR值(95%CI)为1.086(1.010~1.167)。结论CPAP OMPT对37.5%的OSA合并高血压患者的即时降压疗效显著,CPAP OMPT治疗前后LSpO_(2)变化值与改善血压呈正向关联。Objective To explore the immediate antihypertensive efficacy of continuous positive airway pressure(CPAP)overnight manual pressure titration(OMPT)in patients with obstructive sleep apnea(OSA)complicated with hypertension,and the influencing factors related to antihypertensive efficacy.Methods A total of 88 patients diagnosed with OSA complicated with hypertension who were admitted to the Third Hospital of Hebei Medical University from September 2022 to October 2023 due to nocturnal sleep snoring and breath-holding were retrospectively enrolled.All patients were treated with CPAP OMPT during polysomnography(PSG).Based on the immediate antihypertensive effect after CPAP OMPT treatment(changes in blood pressure within 15 minutes before and after treatment),patients were divided into the significant decrease group[group A,systolic blood pressure(SBP)decreased by≥5 mmHg(1 mmHg=0.133 kPa)and diastolic blood pressure(DBP)decreased by≥3 mmHg]and the non-decrease group(group N,SBP decreased by<5 mmHg or DBP decreased by<3 mmHg).The demographic characteristics of the two groups was compared,as well as the differences in apnea-hypopnea index(AHI),time for pulse oxygen saturation<90%[T(SpO_(2)<90%)],oxygen desaturation index(ODI),lowest SpO_(2)during sleep(LSpO_(2)),mean SpO_(2)during sleep(MSpO_(2)).A multivariate logistic regression model was used to analyze the factors associated with the improvement of blood pressure by CPAP OMPT.Results A total of 88 patients with OSA complicated with hypertension were included,with 77 males and 11 females,and aged(46.5±13.2)years.There were 33 cases in group A and 55 cases in group N.CPAP OMPT had a significant effect on immediate blood pressure reduction in 37.5%of patients with OSA complicated with hypertension;there were no significant differences in age,gender composition,neck circumference,history of diabetes mellitus,history of coronary heart disease,and history of hyperlipidemia between the two groups(all P>0.05).After CPAP OMPT treatment,the change values of LSpO_(2)and MS

关 键 词：睡眠呼吸暂停 阻塞性 高血压 连续气道正压通气 整夜人工压力滴定 

分 类 号：R544.1[医药卫生—心血管疾病]