Hui D S, To K W, Ko F W, Fok J P, Chan M C, Ngai J C, Tung A H, Ho C W, Tong M W, Szeto C-C, Yu C-M
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Thorax. 2006 Dec;61(12):1083-90. doi: 10.1136/thx.2006.064063. Epub 2006 Aug 23.
A randomised controlled study was undertaken to examine the effect of nasal continuous positive airway pressure (CPAP) on 24 hour systemic blood pressure (BP) in patients with obstructive sleep apnoea (OSA).
Patients were fitted with an ambulatory BP measuring device as outpatients during normal activities and recorded for 24 hours before starting therapeutic or subtherapeutic (4 cm H(2)O) CPAP treatment. BP monitoring was repeated before completion of 12 weeks of treatment. The primary end point was the change in 24 hour mean BP.
Twenty three of 28 participants in each treatment arm completed the study. There was no significant difference between the two groups in age, body mass index, Epworth Sleepiness Score, apnoea-hypopnoea index, arousal index, and minimum Sao(2). Twenty four patients were hypertensive. The pressure in the therapeutic CPAP group was 10.7 (0.4) cm H(2)O. CPAP usage was 5.1 (0.4) and 2.6 (0.4) hours/night for the therapeutic and subtherapeutic CPAP groups, respectively (p<0.001). After 12 weeks of treatment there were significant differences between the two CPAP groups in mean (SE) changes in 24 hour diastolic BP (-2.4 (1.2) v 1.1 (1.0) mm Hg (95% CI -6.6 to -0.5), p = 0.025); 24 hour mean BP (-2.5 (1.3) v 1.3 (1.1) mm Hg (95% CI -7.2 to -0.2), p = 0.037); sleep time systolic BP (-4.1 (2.1) v 2.2 (1.8) mm Hg (95% CI -11.8 to -0.7), p = 0.028); and sleep time mean BP (-3.6 (1.7) v 1.3 (1.4) mm Hg (95% CI -9.2 to -0.4), p = 0.033).
Compared with subtherapeutic CPAP, 12 weeks of treatment with therapeutic CPAP leads to reductions in 24 hour mean and diastolic BP by 3.8 mm Hg and 3.5 mm Hg, respectively, in mildly sleepy patients with OSA.
开展了一项随机对照研究，以探讨经鼻持续气道正压通气（CPAP）对阻塞性睡眠呼吸暂停（OSA）患者24小时全身血压（BP）的影响。
患者在门诊正常活动期间佩戴动态血压测量装置，并在开始治疗性或亚治疗性（4厘米水柱）CPAP治疗前记录24小时血压。在完成12周治疗前重复进行血压监测。主要终点是24小时平均血压的变化。
每个治疗组的28名参与者中有23名完成了研究。两组在年龄、体重指数、爱泼华嗜睡量表、呼吸暂停低通气指数、觉醒指数和最低血氧饱和度方面无显著差异。24名患者患有高血压。治疗性CPAP组的压力为10.7（0.4）厘米水柱。治疗性和亚治疗性CPAP组的每晚CPAP使用时间分别为5.1（0.4）和2.6（0.4）小时（p<0.001）。治疗12周后，两个CPAP组在24小时舒张压平均（标准误）变化（-2.4（1.2）对1.1（1.0）毫米汞柱（95%可信区间-6.6至-0.5），p = 0.025）；24小时平均血压（-2.5（1.3）对1.3（1.1）毫米汞柱（95%可信区间-7.2至-0.2），p = 0.037）；睡眠时间收缩压（-4.1（2.1）对2.2（1.8）毫米汞柱（95%可信区间-11.8至-0.7），p = 0.028）；以及睡眠时间平均血压（-3.6（1.7）对1.3（1.4）毫米汞柱（95%可信区间-9.2至-0.4），p = 0.033）方面存在显著差异。
与亚治疗性CPAP相比，对轻度嗜睡的OSA患者进行12周的治疗性CPAP治疗可使24小时平均血压和舒张压分别降低3.8毫米汞柱和3.5毫米汞柱。
