Campos-Rodriguez Francisco, Grilo-Reina Antonio, Perez-Ronchel Jose, Merino-Sanchez Mercedes, Gonzalez-Benitez Maria A, Beltran-Robles Manuel, Almeida-Gonzalez Carmen
Department of Respiratory Medicine, University Hospital, 41020 Sevilla, Spain.
Chest. 2006 Jun;129(6):1459-67. doi: 10.1378/chest.129.6.1459.
Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for arterial hypertension. Several controlled trials have investigated the effect of continuous positive airway pressure (CPAP) on BP in patients with OSAS, but its effect on hypertensive patients has not been analyzed specifically.
To analyze the effect of CPAP on ambulatory BP in patients with OSAS and hypertension who were undergoing antihypertensive treatment.
We conducted a parallel, randomized, placebo-controlled trial in 68 patients with OSAS and hypertension, who were receiving treatment with antihypertensive medication. Patients were randomly allocated to either therapeutic or subtherapeutic CPAP for 4 weeks. Ambulatory BP was registered at baseline and after treatment. Antihypertensive treatment was not changed during the study. Changes in BP were assessed on an intention-to-treat basis.
There were no baseline differences in the apnea-hypopnea index, comorbidities, or ambulatory BP between groups. Objective compliance with CPAP was similar in both the therapeutic and subtherapeutic groups (5.0 +/- 1.4 h/d vs 4.4 +/- 1.9 h/d, respectively; p = 0.13 [mean +/- SD]). There was a small and statistically nonsignificant decrease (- 0.3 +/- 6.3 mm Hg vs - 1.1 +/- 7.9 mm Hg; difference, - 0.8 mm Hg [95% confidence interval, - 2.7 to 4.3]; p = 0.65) in 24-h mean BP (24hMBP) in both subtherapeutic and therapeutic groups after 4 weeks of treatment. No significant changes in systolic, diastolic, daytime, or nighttime BP were observed. The normal circadian dipper pattern was restored in a higher proportion of patients in the therapeutic group compared to the subtherapeutic CPAP group, although differences were not significant (11 of 32 patients vs 3 of 25 patients; odds ratio, 3.84; 95% confidence interval, 0.82 to 20.30; p = 0.10). There was no correlation between the magnitude of change in 24hMBP and CPAP compliance, OSAS severity, or number of antihypertensive drugs used.
Four weeks of CPAP did not reduce BP in patients with OSAS and hypertension who were treated with antihypertensive medication, compared to placebo group.
阻塞性睡眠呼吸暂停综合征（OSAS）是动脉高血压的独立危险因素。多项对照试验研究了持续气道正压通气（CPAP）对OSAS患者血压的影响，但尚未专门分析其对高血压患者的影响。
分析CPAP对正在接受抗高血压治疗的OSAS合并高血压患者动态血压的影响。
我们对68例正在接受抗高血压药物治疗的OSAS合并高血压患者进行了一项平行、随机、安慰剂对照试验。患者被随机分配接受治疗性或亚治疗性CPAP治疗4周。在基线和治疗后记录动态血压。研究期间抗高血压治疗不变。基于意向性分析评估血压变化。
两组之间在呼吸暂停低通气指数、合并症或动态血压方面无基线差异。治疗性和亚治疗性组的CPAP客观依从性相似（分别为5.0±1.4小时/天和4.4±1.9小时/天；p = 0.13[均值±标准差]）。治疗4周后，亚治疗性组和治疗性组的24小时平均血压（24hMBP）均有小幅下降且无统计学意义（-0.3±6.3 mmHg对-1.1±7.9 mmHg；差值为-0.8 mmHg[95%置信区间，-2.7至4.3]；p = 0.65）。收缩压、舒张压、日间或夜间血压均未观察到显著变化。与亚治疗性CPAP组相比，治疗性组中有更高比例的患者恢复了正常的昼夜血压波动模式，尽管差异不显著（32例患者中的11例对25例患者中的3例；比值比为3.84；95%置信区间为0.82至20.30；p = 0.10）。24hMBP的变化幅度与CPAP依从性、OSAS严重程度或使用的抗高血压药物数量之间无相关性。
与安慰剂组相比，接受抗高血压药物治疗的OSAS合并高血压患者接受4周CPAP治疗后血压未降低。
