Doherty Liam S, Kiely John L, Swan Valerie, McNicholas Walter T
Respiratory Sleep Disorders Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Chest. 2005 Jun;127(6):2076-84. doi: 10.1378/chest.127.6.2076.
Obstructive sleep apnea syndrome (OSAS) has been associated with increased morbidity and mortality, principally from cardiovascular disease, but the impact of nasal continuous positive airway pressure (CPAP) therapy is unclear.
We performed a long-term follow-up study of 168 patients with OSAS who had begun receiving CPAP therapy at least 5 years previously, most of whom had been prospectively followed up, having been the subject of an earlier report on cardiovascular risk factors in OSAS patients. The average follow-up period was 7.5 years. We compared the cardiovascular outcomes of those patients who were intolerant of CPAP (untreated group, 61 patients) with those continuing CPAP therapy (107 patients).
CPAP-treated patients had a higher median apnea-hypopnea index score than the untreated group (48.3 [interquartile range (IQR), 33.6 to 66.4] vs 36.7 [IQR, 27.4 to 55], respectively; p = 0.02), but age, body mass index, and time since diagnosis were similar. Deaths from cardiovascular disease were more common in the untreated group than in the CPAP-treated group during follow-up (14.8% vs 1.9%, respectively; p = 0.009 [log rank test]), but no significant differences were found in the development of new cases of hypertension, cardiac disorder, or stroke. Total cardiovascular events (ie, death and new cardiovascular disease combined) were more common in the untreated group than in the CPAP-treated group (31% vs 18%, respectively; p < 0.05).
The data support a protective effect of CPAP therapy against death from cardiovascular disease in patients with OSAS.
阻塞性睡眠呼吸暂停综合征（OSAS）与发病率和死亡率增加有关，主要源于心血管疾病，但鼻持续气道正压通气（CPAP）治疗的影响尚不清楚。
我们对168例OSAS患者进行了长期随访研究，这些患者至少在5年前开始接受CPAP治疗，其中大多数患者接受了前瞻性随访，他们曾是一份关于OSAS患者心血管危险因素的早期报告的研究对象。平均随访期为7.5年。我们将不耐受CPAP的患者（未治疗组，61例患者）的心血管结局与继续接受CPAP治疗的患者（107例患者）进行了比较。
接受CPAP治疗的患者的呼吸暂停低通气指数中位数得分高于未治疗组（分别为48.3[四分位间距（IQR），33.6至66.4]和36.7[IQR，27.4至55]；p = 0.02），但年龄、体重指数和诊断后的时间相似。随访期间，未治疗组中心血管疾病死亡比接受CPAP治疗组更常见（分别为14.8%和1.9%；p = 0.009[对数秩检验]），但在高血压、心脏疾病或中风新发病例的发生方面未发现显著差异。总的心血管事件（即死亡和新发心血管疾病合并）在未治疗组比接受CPAP治疗组更常见（分别为31%和18%；p < 0.05）。
数据支持CPAP治疗对OSAS患者心血管疾病死亡具有保护作用。
