治疗和未治疗的阻塞性睡眠呼吸暂停与高血压风险的关系。
Association between treated and untreated obstructive sleep apnea and risk of hypertension.
机构信息
Respiratory Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
出版信息
JAMA. 2012 May 23;307(20):2169-76. doi: 10.1001/jama.2012.3418.
CONTEXT
Systemic hypertension is prevalent among patients with obstructive sleep apnea (OSA). Short-term studies indicate that continuous positive airway pressure (CPAP) therapy reduces blood pressure in patients with hypertension and OSA.
OBJECTIVE
To determine whether CPAP therapy is associated with a lower risk of incident hypertension.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of 1889 participants without hypertension who were referred to a sleep center in Zaragoza, Spain, for nocturnal polysomnography between January 1, 1994, and December 31, 2000. Incident hypertension was documented at annual follow-up visits up to January 1, 2011. Multivariable models adjusted for confounding factors, including change in body mass index from baseline to censored time, were used to calculate hazard ratios (HRs) of incident hypertension in participants without OSA (controls), with untreated OSA, and in those treated with CPAP therapy according to national guidelines.
MAIN OUTCOME MEASURE
Incidence of new-onset hypertension.
RESULTS
During 21,003 person-years of follow-up (median, 12.2 years), 705 cases (37.3%) of incident hypertension were observed. The crude incidence of hypertension per 100 person-years was 2.19 (95% CI, 1.71-2.67) in controls, 3.34 (95% CI, 2.85-3.82) in patients with OSA ineligible for CPAP therapy, 5.84 (95% CI, 4.82-6.86) in patients with OSA who declined CPAP therapy, 5.12 (95% CI, 3.76-6.47) in patients with OSA nonadherent to CPAP therapy, and 3.06 (95% CI, 2.70-3.41) in patients with OSA and treated with CPAP therapy. Compared with controls, the adjusted HRs for incident hypertension were greater among patients with OSA ineligible for CPAP therapy (1.33; 95% CI, 1.01-1.75), among those who declined CPAP therapy (1.96; 95% CI, 1.44-2.66), and among those nonadherent to CPAP therapy (1.78; 95% CI, 1.23-2.58), whereas the HR was lower in patients with OSA who were treated with CPAP therapy (0.71; 95% CI, 0.53-0.94).
CONCLUSION
Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension.
背景
阻塞性睡眠呼吸暂停（OSA）患者中普遍存在系统性高血压。短期研究表明，持续气道正压通气（CPAP）治疗可降低高血压合并 OSA 患者的血压。
目的
确定 CPAP 治疗是否与新发高血压的风险降低相关。
设计、地点和参与者：这是一项前瞻性队列研究，共纳入 1889 名无高血压的参与者，他们于 1994 年 1 月 1 日至 2000 年 12 月 31 日期间因夜间多导睡眠图检查被转诊至西班牙萨拉戈萨的睡眠中心。在截至 2011 年 1 月 1 日的年度随访中记录新发高血压情况。使用多变量模型调整混杂因素，包括从基线到删失时间的体重指数变化，以计算无 OSA（对照组）、未经治疗的 OSA 以及根据国家指南接受 CPAP 治疗的 OSA 患者中新发高血压的发生率。
主要结局测量
新发高血压的发生率。
结果
在 21003 人年的随访期间（中位数 12.2 年），观察到 705 例（37.3%）新发高血压病例。对照组每 100 人年的高血压粗发生率为 2.19（95%CI，1.71-2.67），未接受 CPAP 治疗的 OSA 患者为 3.34（95%CI，2.85-3.82），拒绝 CPAP 治疗的 OSA 患者为 5.84（95%CI，4.82-6.86），CPAP 治疗依从性差的 OSA 患者为 5.12（95%CI，3.76-6.47），接受 CPAP 治疗的 OSA 患者为 3.06（95%CI，2.70-3.41）。与对照组相比，未接受 CPAP 治疗的 OSA 患者（HR，1.33；95%CI，1.01-1.75）、拒绝 CPAP 治疗的 OSA 患者（HR，1.96；95%CI，1.44-2.66）和 CPAP 治疗依从性差的 OSA 患者（HR，1.78；95%CI，1.23-2.58）发生新发高血压的调整后 HR 更高，而接受 CPAP 治疗的 OSA 患者（HR，0.71；95%CI，0.53-0.94）的 HR 更低。
结论
与无 OSA 的患者相比，OSA 的存在与新发高血压的风险增加相关；然而，CPAP 治疗与降低高血压风险相关。
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