持续气道正压通气对冠心病合并阻塞性睡眠呼吸暂停高血压患者血压及预后的长期影响：一项随机对照试验
Long-term effects of continuous positive airway pressure on blood pressure and prognosis in hypertensive patients with coronary heart disease and obstructive sleep apnea: a randomized controlled trial.
作者信息
Huang Zhiwei, Liu Zhihong, Luo Qin, Zhao Qing, Zhao Zhihui, Ma Xiuping, Liu Weihua, Yang Dan
机构信息
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Am J Hypertens. 2015 Mar;28(3):300-6. doi: 10.1093/ajh/hpu147. Epub 2014 Aug 14.
BACKGROUND
Obstructive sleep apnea (OSA) can result in hypertension and significantly increase cardiovascular morbidity and mortality. There are few reports on the long-term effects of continuous positive airway pressure (CPAP) on blood pressure in patients with uncontrolled hypertension with coronary heart disease (CHD) and OSA.
METHODS
We conducted a prospective, long-term follow-up study in 83 patients with uncontrolled hypertension, CHD, and OSA randomized to control or CPAP groups. Daytime systolic blood pressure (SBP), diastolic blood pressure (DBP), and severe cardiovascular and cerebrovascular events (SCCEs) were recorded at baseline and follow-up.
RESULTS
Seventy-three patients completed the study with a median follow-up of 36 (interquartile range = 24-54) months. The 2 groups had similar characteristics at baseline. CPAP was used for 4.5±1.1 hour/night. SBP in the CPAP group was significantly reduced at follow-up (143±7 mm Hg vs. 139±7 mm Hg, P = 0.04), and SBP decreased by 8mm Hg (95% confidence interval = 1.4-9.9; P = 0.01). Hypertension control was improved (CPAP, 69.4% for CPAP users vs. 43.2% for control subjects; P = 0.02); however, DBP did not reach statistical difference between the groups (81±10 mm Hg vs. 79±8 mm Hg; P = 0.49). In the CPAP group, the Epworth Sleepiness Scale was markedly reduced (7.0±3.4 vs. 3.7±2.3; P < 0.001). There was 1 SCCE in the CPAP group (heart failure), and 5 SCCEs in the control group (acute myocardial infarction: 2 (with 1 death); stroke: 3), but there was no significant difference identified.
CONCLUSIONS
Long-term CPAP application in uncontrolled hypertension with CHD and OSA significantly reduced daytime SBP, improved hypertension control and daytime sleepiness, and decreased the trend in SCCEs compared with control subjects.
CLINICAL TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT02059993.
背景
阻塞性睡眠呼吸暂停（OSA）可导致高血压，并显著增加心血管疾病的发病率和死亡率。关于持续气道正压通气（CPAP）对合并冠心病（CHD）和OSA的未控制高血压患者血压的长期影响，报道较少。
方法
我们对83例合并CHD和OSA的未控制高血压患者进行了一项前瞻性长期随访研究，这些患者被随机分为对照组和CPAP组。在基线和随访时记录白天收缩压（SBP）、舒张压（DBP）以及严重的心脑血管事件（SCCEs）。
结果
73例患者完成了研究，中位随访时间为36（四分位间距=24 - 54）个月。两组在基线时具有相似的特征。CPAP使用时间为4.5±1.1小时/晚。随访时CPAP组的SBP显著降低（143±7 mmHg对139±7 mmHg，P = 0.04），SBP下降了8 mmHg（95%置信区间=1.4 - 9.9；P = 0.01）。高血压控制情况得到改善（CPAP组CPAP使用者为69.4%，对照组为43.2%；P = 0.02）；然而，两组间DBP未达到统计学差异（81±10 mmHg对79±8 mmHg；P = 0.49）。在CPAP组，爱泼沃斯嗜睡量表评分显著降低（7.0±3.4对3.7±2.3；P < 0.001）。CPAP组有1例SCCE（心力衰竭），对照组有5例SCCE（急性心肌梗死：2例（其中1例死亡）；中风：3例），但未发现显著差异。
结论
与对照组相比，对合并CHD和OSA的未控制高血压患者长期应用CPAP可显著降低白天SBP，改善高血压控制和白天嗜睡情况，并降低SCCEs的发生趋势。
临床试验注册号
ClinicalTrials.gov NCT02059993。
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