Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy.
Clin Exp Hypertens. 2011;33(6):373-80. doi: 10.3109/10641963.2010.531853. Epub 2011 May 2.
Treatment of obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) usually causes a reduction in blood pressure (BP), but several factors may interfere with its effects. In addition, although a high sympathetic activity is considered a major contributor to increased BP in OSA, a relationship between changes in BP and in sympathetic nervous system activity after OSA treatment is uncertain. This study was undertaken to assess if, in OSA subjects under no pharmacologic treatment, treatment by CPAP applied at variable levels by an automatic device (APAP) may be followed by a BP reduction, and if that treatment is associated with parallel changes in BP and catecholamine excretion during the sleep hours. Nine subjects underwent 24-h ambulatory BP monitoring and nocturnal urinary catecholamine determinations before OSA treatment and 2 months following OSA treatment by APAP (Somnosmart2, Weinmann, Hamburg, Germany). Eight control subjects were treated by CPAP at a fixed level. After APAP treatment, systolic blood pressure (SBP) decreased during sleep (p < 0.05), while diastolic blood pressure (DBP) decreased both during wakefulness (p < 0.05) and sleep (p < 0.02). Similar changes were observed in subjects receiving fixed CPAP. Nocturnal DBP changes were correlated with norepinephrine (in the whole sample: r = .61, p < 0.02) and normetanephrine (r = .71, p < 0.01) changes. In OSA subjects under no pharmacologic treatment, APAP reduces BP during wakefulness and sleep, similarly to CPAP. A reduction in nocturnal sympathetic activity could contribute to the reduction in DBP during sleep following OSA treatment.
持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停（OSA）通常会降低血压（BP），但有几个因素可能会干扰其效果。此外，尽管高交感神经活动被认为是 OSA 中血压升高的主要原因，但 OSA 治疗后 BP 和交感神经系统活动变化之间的关系尚不确定。本研究旨在评估在未接受药物治疗的 OSA 患者中，自动设备（APAP）施加的可变 CPAP 治疗后是否会出现 BP 降低，以及该治疗是否与睡眠期间 BP 和儿茶酚胺排泄的平行变化相关。9 名受试者在 OSA 治疗前和 OSA 治疗后 2 个月（使用 Somnosmart2，Weinmann，Hamburg，德国）接受了 24 小时动态血压监测和夜间尿儿茶酚胺测定。8 名对照受试者接受固定 CPAP 治疗。APAP 治疗后，睡眠期间收缩压（SBP）降低（p < 0.05），而清醒时（p < 0.05）和睡眠时（p < 0.02）舒张压（DBP）均降低。接受固定 CPAP 治疗的患者也观察到类似的变化。夜间 DBP 变化与去甲肾上腺素（在整个样本中：r =.61，p < 0.02）和变肾上腺素（r =.71，p < 0.01）变化相关。在未接受药物治疗的 OSA 患者中，APAP 可降低清醒和睡眠期间的 BP，与 CPAP 相似。OSA 治疗后睡眠期间 DBP 降低可能与夜间交感神经活动减少有关。
