Divisione di Medicina Interna, Laboratorio per le patologie sonno-correlate, Ospedale di Umbertide, Perugia, Italy.
Respir Med. 2012 Sep;106(9):1329-34. doi: 10.1016/j.rmed.2012.05.007. Epub 2012 Jun 28.
Obstructive sleep apnea-hypopnea (OSAH) is a risk factor for development of systemic arterial hypertension (SAH) and can worse the control of established SAH. We investigated the effects of long-term continuous positive airway pressure (CPAP) treatment in controlling and preventing SAH in a large cohort of subjects referred for sleep study for suspected OSAH.
In 495 subjects of whom 422 with OSAH and 73 without OSAH, the clinical history was obtained, arterial blood pressure was measured and the current anti-hypertensive drugs was recorded at diagnosis and/or at CPAP start. Subjects were interviewed after a follow-up period of (mean ± SD) 3.4 ± 2.2 yr (range 1-8 yr) and divided in patients with moderate-to-severe OSAH (n = 125) who referred to use CPAP regularly for at least 4 h every night (group 1), with moderate-to-severe OSAH (n = 70) who refused or abandoned the CPAP treatment after few weeks (group 2), with mild OSAH (n = 227) with no CPAP indication (group 3) and simple snorers or normals (n = 73) (group 4). For each group clinical status, BMI, and changes in SAH therapy and occurrence of SAH were assessed at the follow-up.
At the follow-up, a higher risk of increasing treatment for SAH was found for group 2 and group 3 versus group 1 (OR = 5, 95%CI 1-20, p < 0.01 and OR = 3, 95%CI 1-10, p < 0.05), respectively. The occurrence of SAH was lower (p < 0.001) in the group 1 (1.9%), vs group 2 (35.9%), 3 (21.1%) and 4 (18.6%).
In moderate-to-severe OSAH patients, long-term CPAP treatment significantly reduces the development of SAH and, in those with SAH at baseline, the need of anti-hypertensive drugs.
阻塞性睡眠呼吸暂停低通气（OSAH）是全身性动脉高血压（SAH）发展的一个风险因素，并可能使已确诊的 SAH 控制更加恶化。我们研究了在一大群因疑似 OSAH 而接受睡眠研究的患者中，长期持续气道正压通气（CPAP）治疗对控制和预防 SAH 的影响。
在 495 名患者中，422 名患有 OSAH，73 名没有 OSAH，在诊断和/或 CPAP 开始时获取临床病史，测量动脉血压并记录当前的抗高血压药物。在平均（±SD）3.4±2.2 年（范围 1-8 年）的随访后对患者进行了采访，并根据患者的 OSAH 严重程度将患者分为以下几组：中重度 OSAH 患者（n=125），他们定期使用 CPAP 治疗，每晚至少 4 小时（组 1）；中重度 OSAH 患者（n=70）拒绝或在几周后放弃 CPAP 治疗（组 2）；轻度 OSAH 患者（n=227）无 CPAP 适应证（组 3）；单纯打鼾者或正常人（n=73）（组 4）。对于每组患者，在随访时评估临床状况、BMI 以及 SAH 治疗的变化和 SAH 的发生情况。
在随访中，与组 1 相比，组 2 和组 3 中 SAH 治疗增加的风险更高（OR=5，95%CI 1-20，p<0.01 和 OR=3，95%CI 1-10，p<0.05）。SAH 的发生率在组 1（1.9%）中较低（p<0.001），而在组 2（35.9%）、组 3（21.1%）和组 4（18.6%）中较高。
在中重度 OSAH 患者中，长期 CPAP 治疗可显著降低 SAH 的发生，并且在基线时患有 SAH 的患者中，还可降低抗高血压药物的需求。
