Kyrgyz State Medical Academy named after I,K, Akhunbaev, Akhunbaev Street 92, Bishkek 720020, Kyrgyzstan.
BMC Pulm Med. 2012 May 17;12:16. doi: 10.1186/1471-2466-12-16.
Obstructive sleep apnea (OSA) and arterial hypertension (AH) are common and underrecognized medical disorders. OSA is a potential risk factor for the development of AH and/or may act as a factor complicating AH management. The symptoms of excessive daytime sleepiness (EDS) are considered essential for the initiation of continuous positive airway pressure (CPAP) therapy, which is a first line treatment of OSA. The medical literature and practice is controversial about the treatment of people with asymptomatic OSA. Thus, OSA patients without EDS may be left at increased cardiovascular risk.
The report presents a case of 42 year old Asian woman with symptoms of heart failure and angina like chest pain upon admission. She didn't experience symptoms of EDS, and the Epworth Sleepiness Scale was seven points. Snoring was reported on direct questioning. The patient had prior medical history of three unsuccessful pregnancies complicated by gestational AH and preeclampsia with C-section during the last pregnancy. The admission blood pressure (BP) was 200/120 mm Hg. The patients treatment regimen consisted of five hypotensive medications including diuretic. However, a target BP wasn't achieved in about one and half month. The patient was offered to undergo a polysomnography (PSG) study, which she rejected. One month after discharge the PSG study was done, and this showed an apnea-hypopnea index (AHI) of 46 events per hour. CPAP therapy was initiated with a pressure of 11 H₂0 cm. After 2 months of compliant CPAP use, adherence to pharmacologic regimen and lifestyle modifications the patients BP decreased to 134/82 mm Hg.
OSA and AH are common and often underdiagnosed medical disorders independently imposing excessive cardiovascular risk on a diseased subject. When two conditions coexist the cardiovascular risk is likely much greater. This case highlights a possible clinical phenotype of OSA without EDS and its association with resistant AH. Most importantly a good hypotensive response to medical treatment in tandem with CPAP therapy was achieved in this patient. Thus, it is reasonable to include OSA in the differential list of resistant AH, even if EDS is not clinically obvious.
阻塞性睡眠呼吸暂停（OSA）和动脉高血压（AH）是常见且未被充分认识的医学疾病。OSA 是 AH 发展的潜在危险因素，或者可能成为 AH 管理复杂化的因素。白天过度嗜睡（EDS）的症状被认为是开始持续气道正压通气（CPAP）治疗的必要条件，CPAP 治疗是 OSA 的一线治疗方法。医学文献和实践对于无症状 OSA 患者的治疗存在争议。因此，没有 EDS 的 OSA 患者可能会面临更高的心血管风险。
本报告介绍了一位 42 岁的亚裔女性病例，她因心力衰竭和心绞痛样胸痛入院。她没有 EDS 症状，Epworth 嗜睡量表评分为 7 分。直接询问时报告有打鼾。患者既往有三次妊娠失败的病史，妊娠期间并发妊娠期 AH 和子痫前期，最后一次妊娠行剖宫产。入院时血压（BP）为 200/120mmHg。患者的治疗方案包括五种降压药物，包括利尿剂。然而，大约一个半月后仍未达到目标 BP。建议患者进行多导睡眠图（PSG）检查，但她拒绝了。出院后一个月进行了 PSG 检查，结果显示每小时呼吸暂停-低通气指数（AHI）为 46 次。给予 CPAP 治疗，压力为 11cmH₂O。在接受 CPAP 治疗 2 个月且坚持药物治疗和生活方式改变后，患者的 BP 降至 134/82mmHg。
OSA 和 AH 是常见的且经常被漏诊的医学疾病，它们各自给患病个体带来过度的心血管风险。当两种疾病同时存在时，心血管风险可能更大。本病例突出了一种可能的无 EDS 的 OSA 临床表型及其与难治性 AH 的关联。最重要的是，该患者对药物治疗和 CPAP 治疗的联合治疗有很好的降压反应。因此，即使 EDS 临床上不明显，也有理由将 OSA 纳入难治性 AH 的鉴别诊断清单。
