Schein Andressa S O, Kerkhoff Alessandra C, Coronel Christian C, Plentz Rodrigo D M, Sbruzzi Graciele
aInstituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia bUniversidade Federal do Rio Grande do Sul cUniversidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
J Hypertens. 2014 Sep;32(9):1762-73. doi: 10.1097/HJH.0000000000000250.
Obstructive sleep apnea (OSA) may lead to the development of hypertension and therapy with continuous positive airway pressure (CPAP) can promote reduction in blood pressure.
The objective of this study is to review systematically the effects of CPAP on blood pressure in patients with OSA.
The search was conducted in the following databases, from their beginning until February 2013: MEDLINE, Embase, Cochrane CENTRAL, Lilacs and PEDro. In addition, a manual search was performed on references of published studies. Randomized clinical trials (RCTs) that used CPAP compared with placebo CPAP or subtherapeutic CPAP for treatment of patients with OSA and that evaluated office SBP and DBP and 24-h ambulatory blood pressure were selected.
Sixteen RCTs were included among 3409 publications, totaling 1166 patients. The use of CPAP resulted in reductions in office SBP [-3.20 mmHg; 95% confidence interval (CI) -4.67 to -1.72] and DBP (-2.87 mmHg; 95% CI -5.18 to -0.55); in night-time SBP (-4.92 mmHg; 95% CI -8.70 to -1.14); in mean 24-h blood pressure (-3.56 mmHg; 95% CI -6.79 to -0.33), mean night-time blood pressure (-2.56 mmHg; 95% CI -4.43 to -0.68) and 24-h DBP (-3.46 mmHg; 95% CI -6.75 to -0.17). However, no significant change was observed in daytime SBP (-0.74 mmHg; 95% CI -3.90 to 2.41) and daytime DBP (-1.86 mmHg; 95% CI -4.55 to 0.83).
Treatment with CPAP promoted significantly but small reductions in blood pressure in individuals with OSA. Further studies should be performed to evaluate the effects of long-term CPAP and the impact on cardiovascular risk.
阻塞性睡眠呼吸暂停（OSA）可能导致高血压的发生，持续气道正压通气（CPAP）治疗可促进血压降低。
本研究的目的是系统回顾CPAP对OSA患者血压的影响。
检索以下数据库，从建库至2013年2月：MEDLINE、Embase、Cochrane CENTRAL、Lilacs和PEDro。此外，对已发表研究的参考文献进行了手工检索。选择使用CPAP与安慰剂CPAP或亚治疗性CPAP对比治疗OSA患者且评估诊室收缩压（SBP）和舒张压（DBP）以及24小时动态血压的随机临床试验（RCT）。
3409篇出版物中纳入了16项RCT，共1166例患者。使用CPAP可使诊室SBP降低[-3.20 mmHg；95%置信区间（CI）-4.67至-1.72]，DBP降低（-2.87 mmHg；95% CI -5.18至-0.55）；夜间SBP降低（-4.92 mmHg；95% CI -8.70至-1.14）；24小时平均血压降低（-3.56 mmHg；95% CI -6.79至-0.33），夜间平均血压降低（-2.56 mmHg；95% CI -4.43至-0.68），24小时DBP降低（-3.46 mmHg；95% CI -6.75至-0.17）。然而，日间SBP（-0.74 mmHg；95% CI -3.90至2.41）和日间DBP（-1.86 mmHg；95% CI -4.55至0.83）未观察到显著变化。
CPAP治疗可使OSA患者血压显著但小幅降低。应进一步开展研究以评估长期CPAP的效果及其对心血管风险的影响。
