Heitmann J, Ehlenz K, Penzel T, Becker H F, Grote L, Voigt K H, Peter J Hermann, Vogelmeier C
Sleep Laboratory, Division of Pulmonary Diseases, Dept of Internal Medicine, Marburg University, Germany.
Eur Respir J. 2004 Feb;23(2):255-62. doi: 10.1183/09031936.04.00015604.
There is increasing evidence that nasal continuous positive airway pressure (nCPAP) lowers blood pressure in obstructive sleep apnoea (OSA) patients, not only during sleep but also in the daytime. However, both the mechanisms of blood pressure reduction and the considerable differences in the magnitude of the effect in the studies presented to date are not fully understood. Therefore, the authors prospectively studied the effect of nCPAP on noradrenaline plasma levels (NApl), blood pressure and heart rate (HR) in 10 normotensive and eight hypertensive OSA patients before and after 41.6 +/- 16.9 days of nCPAP therapy. Polysomnography and invasive blood pressure were continuously monitored over 24 h in the supine position before and with nCPAP. NApl were analysed every 15 min. In hypertensives, nCPAP reduced NApl by 36 +/- 25%, lowered mean arterial blood pressure substantially (night-time: -8.89 +/- 14.09 mmHg; daytime: -7.94 +/- 10.47 mmHg) and decreased HR by 6.6 +/- 5.4 beats x min(-1), whereas in normotensives there were only minor changes. The decrease in heart rate was associated with a decrease in mean arterial blood pressure and noradrenaline plasma levels, suggesting a causal effect of nasal continuous positive airway pressure therapy. This nasal continuous positive airway pressure effect occurs mainly in hypertensive obstructive sleep apnoea patients, whereas the effect is small in normotensives. This may explain, at least in part, some of the discrepant results in previous treatment studies.
越来越多的证据表明，经鼻持续气道正压通气（nCPAP）可降低阻塞性睡眠呼吸暂停（OSA）患者的血压，不仅在睡眠期间，白天也如此。然而，迄今为止，血压降低的机制以及研究中效应大小的显著差异尚未完全明确。因此，作者前瞻性地研究了nCPAP对10名血压正常和8名高血压OSA患者在接受41.6±16.9天nCPAP治疗前后血浆去甲肾上腺素水平（NApl）、血压和心率（HR）的影响。在仰卧位，使用多导睡眠图和有创血压监测仪在使用nCPAP前后对患者进行24小时连续监测。每15分钟分析一次NApl。在高血压患者中，nCPAP使NApl降低了36±25%，显著降低了平均动脉血压（夜间：-8.89±14.09 mmHg；白天：-7.94±10.47 mmHg），并使HR降低了6.6±5.4次/分钟，而在血压正常的患者中只有轻微变化。心率的降低与平均动脉血压和血浆去甲肾上腺素水平的降低相关，提示经鼻持续气道正压通气治疗有因果效应。这种经鼻持续气道正压通气效应主要发生在高血压阻塞性睡眠呼吸暂停患者中，而在血压正常的患者中效应较小。这可能至少部分解释了先前治疗研究中一些相互矛盾的结果。
