CPAP 治疗对阻塞性睡眠呼吸暂停患者交感神经迷走神经平衡和动脉僵硬度的影响。

Effects of CPAP therapy on the sympathovagal balance and arterial stiffness in obstructive sleep apnea.

机构信息

Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.

出版信息

Respir Med. 2010 Jun;104(6):911-6. doi: 10.1016/j.rmed.2010.01.010. Epub 2010 Feb 6.

DOI:10.1016/j.rmed.2010.01.010

PMID:20138492

Abstract

OBJECTIVE

Increased arterial stiffness and sympathovagal imbalance are noted in patients with obstructive sleep apnea (OSA). It has been thought that continuous positive airway pressure (CPAP) therapy can have beneficial effects on the vascular function in such cases. However, it is not yet clear whether the improvement of sympathovagal balance by CPAP might be related to reduction of the arterial stiffness, independent of changes in the blood pressure.

METHODS

In 50 consecutive eligible patients with OSA (apnea-hypopnea index>/=20/hour) receiving CPAP therapy, the brachial-ankle pulse wave velocity (baPWV), heart rate variability (LF, HF and LF/HF ratio), baroreceptor sensitivity (BRS), plasma levels of C-reactive protein (CRP), and endothelial function as assessed by changes in the forearm blood flow before and after reactive hyperemia (END) were measured before and after 3-months' CPAP therapy.

RESULTS

Significant decrease of the LF/HF ratio, plasma levels of CRP, baPWV and heart rate were observed after 3 months' CPAP therapy. The change in the baPWV following 3-months' CPAP therapy was significantly correlated with the change in the LF/HF ratio and mean blood pressure (MBP), but not with that of the BRS, CRP or END after the therapy. Multivariate linear regression analysis demonstrated a significant correlation between the change in the LF/HF ratio and that in the baPWV (beta=0.305, p=0.041), independent of the changes in the MBP, plasma CRP levels and heart rate.

CONCLUSIONS

Improvement of the sympathovagal balance by CPAP therapy may be significantly related to decreased stiffness of the central to middle-sized arteries, independent of the changes in the blood pressure and vascular endothelial status.

摘要

目的

阻塞性睡眠呼吸暂停（OSA）患者的动脉僵硬度增加和交感神经迷走神经失衡。人们认为持续气道正压通气（CPAP）治疗对此类患者的血管功能具有有益作用。但是，CPAP 改善交感神经迷走神经平衡是否与动脉僵硬度的降低有关，而与血压变化无关，目前尚不清楚。

方法

在 50 例连续符合条件的接受 CPAP 治疗的 OSA 患者（呼吸暂停低通气指数≥20/小时）中，测量肱踝脉搏波速度（baPWV）、心率变异性（LF、HF 和 LF/HF 比值）、压力感受器敏感性（BRS）、血浆 C-反应蛋白（CRP）水平以及通过前臂血流变化评估的内皮功能反应性充血前后（END）。在 3 个月的 CPAP 治疗前后分别进行了测量。

结果

CPAP 治疗 3 个月后，LF/HF 比值、血浆 CRP 水平、baPWV 和心率均显著降低。CPAP 治疗 3 个月后，baPWV 的变化与 LF/HF 比值和平均血压（MBP）的变化显著相关，但与 BRS、CRP 或治疗后 END 的变化无关。多元线性回归分析显示，LF/HF 比值的变化与 baPWV 的变化之间存在显著相关性（β=0.305，p=0.041），与 MBP、血浆 CRP 水平和心率的变化无关。