持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者顽固性高血压的疗效

[Efficacy of continuous positive airway pressure therapy upon resistant hypertension in patients with obstructive sleep apnea hypopnea syndrome].

作者信息

Zhang Xi-Long, Li Yan-Qun

机构信息

Department of Respiratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Jul 14;89(26):1811-4.

PMID:19953923

Abstract

OBJECTIVE

To investigate the efficacy and possible mechanism of continuous positive airway pressure (CPAP) therapy upon blood pressure in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and resistant hypertension (RH).

METHODS

Thirteen OSAHS patients with RH were recruited. Before and after 3-month CPAP therapy, their blood pressures at 10:00 PM, 2:00 AM and 6:00 AM were measured and their morning plasma concentrations of aldosterone (ALD) and plasma renin activity (PRA) tested at supine position with radioimmunoassay.

RESULTS

Compared with blood pressure parameters at pre-CPAP therapy, there was a significant decrease in blood pressure before sleep at the end of 3-month CPAP therapy [(135.5 +/- 2.8)/(84.2 +/- 4.6) vs (152.2 +/- 19.2)/(98.9 +/- 15.6) mm Hg, P < 0.01], at night during sleep [ (133.1 +/- 2.4)/(81.5 +/- 4.6) vs (156.6 +/- 19.4)/(102.8 +/- 16.6) mm Hg, P < 0.01] and in the early morning [(151.5 +/- 3.0)/(81.2 +/- 3.2) vs (172.1 +/- 23.7)/(98.1 +/- 6.5) mm Hg, P < 0.01]. Comparison of plasma concentrations of ALD and PRA before and after 3-month CPAP therapy indicated that there was a significant difference in ALD [(538 +/- 42) vs (408 +/- 53) pmol/L, P < 0.01] but not significantly different in PRA [(0.27 +/- 0.14) microg x L(-1) x h(-1) vs (0.20 +/- 0.12), P = 0.221].

CONCLUSIONS

CPAP therapy could significantly improve RH and plasma ALD concentration. Elevated plasma ALD concentration is possibly involved in the pathogenesis of RH in OSAHS patients.

摘要

目的

探讨持续气道正压通气（CPAP）治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并顽固性高血压（RH）患者血压的疗效及可能机制。

方法

招募13例OSAHS合并RH患者。在CPAP治疗3个月前后，测量其晚上10点、凌晨2点和早上6点的血压，并采用放射免疫法检测其清晨卧位血浆醛固酮（ALD）浓度和血浆肾素活性（PRA）。

结果

与CPAP治疗前的血压参数相比，CPAP治疗3个月结束时，睡前血压显著降低[（135.5±2.8）/（84.2±4.6）mmHg 对（152.2±19.2）/（98.9±15.6）mmHg，P<0.01]，夜间睡眠期间血压显著降低[（133.1±2.4）/（81.5±4.6）mmHg 对（156.6±19.4）/（102.8±16.6）mmHg，P<0.01]，清晨血压显著降低[（151.5±3.0）/（81.2±3.2）mmHg 对（172.1±23.7）/（98.1±6.5）mmHg，P<0.01]。3个月CPAP治疗前后血浆ALD和PRA浓度比较显示，ALD有显著差异[（538±42）对（408±53）pmol/L，P<0.01]，但PRA无显著差异[（0.27±0.14）μg·L⁻¹·h⁻¹对（0.20±0.12），P = 0.221]。