Tulmaç Murat, Tireli Emine, Ebinç Haksun, Şimşek Vedat, Doğru Mehmet Tolga, Yıldırım Nesligül, Kısa Üçler, Ekici Mehmet Savaş
Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale-Turkey.
Anadolu Kardiyol Derg. 2012 Nov;12(7):560-5. doi: 10.5152/akd.2012.181. Epub 2012 Jul 17.
In this prospective study, we aimed to investigate acute effect of nasal continuous positive airway pressure (CPAP) therapy on the endothelial function of patients with obstructive sleep apnea syndrome (OSA) by using brachial artery flow mediated dilatation (FMD) method.
Newly diagnosed thirty OSA patients with ages between 29 and 72 years were included in this study. FMD and high sensitivity C-reactive protein (hsCRP) values of patients obtained before and after CPAP dose titration test were compared with paired samples t test or Wilcoxon signed ranks test.
With CPAP therapy apnea hypopnea indices were reduced (60.6±24.9/h vs. 9.6±7.9/h; p<0.001) and oxygen desaturation indices recovered (50±27/h vs. 6±7/h; p<0.001). Heart rates of patients decreased after CPAP therapy (80±10/min vs. 73±8/min; p=0.003). FMD values significantly increased after CPAP (8.55±5.82 percent vs. 12.08±7.17 percent; p=0.003). HsCRP values after CPAP were not different from baseline values.
Acute improvement of the endothelial function with one night CPAP therapy suggests endothelial dysfunction in OSA patients to be result of acute pathophysiologic factors. In intermediate and severe OSA patients, CPAP therapy may be considered in acute treatment of diseases associated with endothelial dysfunction.
在这项前瞻性研究中,我们旨在通过肱动脉血流介导的血管舒张(FMD)方法,研究鼻持续气道正压通气(CPAP)治疗对阻塞性睡眠呼吸暂停综合征(OSA)患者内皮功能的急性影响。
本研究纳入了30例新诊断的年龄在29至72岁之间的OSA患者。采用配对样本t检验或Wilcoxon符号秩检验比较患者在CPAP剂量滴定试验前后获得的FMD和高敏C反应蛋白(hsCRP)值。
CPAP治疗后,呼吸暂停低通气指数降低(60.6±24.9次/小时 vs. 9.6±7.9次/小时;p<0.001),氧饱和度下降指数恢复(50±27次/小时 vs. 6±7次/小时;p<0.001)。CPAP治疗后患者心率下降(80±10次/分钟 vs. 73±8次/分钟;p=0.003)。CPAP治疗后FMD值显著增加(8.55±5.82% vs. 12.08±7.17%;p=0.003)。CPAP治疗后的hsCRP值与基线值无差异。
一晚的CPAP治疗使内皮功能急性改善,提示OSA患者的内皮功能障碍是急性病理生理因素的结果。对于中重度OSA患者,在急性治疗与内皮功能障碍相关的疾病时可考虑使用CPAP治疗。