Hla K Mae, Skatrud James B, Finn Laurel, Palta Mari, Young Terry
Department of Medicine, Section of General Internal Medicine, University of Wisconsin Medical School, 2828 Marshall Court, Suite 100, Madison, WI 53705, USA.
Chest. 2002 Oct;122(4):1125-32. doi: 10.1378/chest.122.4.1125.
To compare BP response to 3 weeks of nasal continuous positive airway pressure (CPAP) in hypertensive patients with and without sleep-disordered breathing (SDB).
A controlled, interventional trial of nasal CPAP in patients with and without SDB.
Twenty-four men, aged 30 to 60 years, with mild to moderate untreated hypertension recruited from employee health and primary care clinics.
Based on in-laboratory polysomnography, 14 hypertensive patients had SDB, defined by five or more episodes of apnea and hypopnea per hour of sleep (apnea-hypopnea index [AHI], > or = 5), and 10 had no SDB (AHI, < 5). We performed 24-h ambulatory BP monitoring on all patients at baseline, during CPAP, and after CPAP treatment. In patients with an AHI > or = 5, nasal CPAP was titrated to reduce the AHI to < 5. Patients with an AHI < 5 received CPAP of 5 cm H(2)O to control for any potential effect of CPAP per se on BP. Both groups received CPAP for 3 weeks.
After adjusting for age and body mass index, the mean nocturnal systolic and diastolic BP changes after CPAP treatment in the SDB group were significantly different from those in the no-SDB group: -7.8 vs +0.3 mm Hg (p = 0.02), and -5.3 vs -0.7 mm Hg (p = 0.03), respectively. There was a similar, although statistically insignificant, difference in the adjusted mean daytime systolic and diastolic BP changes after CPAP treatment between the two groups (-2.7 vs +0.4 mm Hg and -2.3 vs -1.7 mm Hg, respectively).
Three weeks of nasal CPAP treatment of SDB in hypertensive men caused the lowering of nocturnal systolic and diastolic BP values, suggesting that increased nocturnal BP in persons with hypertension was causally related to the apnea and hypopnea events of SDB.
比较有和没有睡眠呼吸紊乱（SDB）的高血压患者对3周鼻腔持续气道正压通气（CPAP）的血压反应。
一项对有和没有SDB的患者进行鼻腔CPAP的对照干预试验。
从员工健康诊所和初级保健诊所招募的24名年龄在30至60岁之间、患有轻度至中度未经治疗高血压的男性。
根据实验室多导睡眠图，14名高血压患者患有SDB，定义为每小时睡眠中出现5次或更多次呼吸暂停和呼吸不足发作（呼吸暂停低通气指数[AHI]，≥5），10名患者没有SDB（AHI，<5）。我们在基线、CPAP治疗期间和CPAP治疗后对所有患者进行了24小时动态血压监测。对于AHI≥5的患者，调整鼻腔CPAP以将AHI降低至<5。AHI<5的患者接受5 cm H₂O的CPAP，以控制CPAP本身对血压的任何潜在影响。两组均接受CPAP治疗3周。
在调整年龄和体重指数后，SDB组CPAP治疗后的夜间平均收缩压和舒张压变化与无SDB组有显著差异：分别为-7.8 vs +0.3 mmHg（p = 0.02）和-5.3 vs -0.7 mmHg（p = 0.03）。两组在CPAP治疗后调整后的日间平均收缩压和舒张压变化也有类似差异，尽管在统计学上不显著（分别为-2.7 vs +0.4 mmHg和-2.3 vs -1.7 mmHg）。
对高血压男性的SDB进行3周鼻腔CPAP治疗可降低夜间收缩压和舒张压值，表明高血压患者夜间血压升高与SDB的呼吸暂停和呼吸不足事件存在因果关系。
