持续气道正压通气对顽固性高血压合并阻塞性睡眠呼吸暂停患者血压的影响：一项荟萃分析。
Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis.
作者信息
Iftikhar Imran H, Valentine Christopher W, Bittencourt Lia R A, Cohen Debbie L, Fedson Annette C, Gíslason Thorarinn, Penzel Thomas, Phillips Craig L, Yu-sheng Lin, Pack Allan I, Magalang Ulysses J
机构信息
aDivision of Pulmonary, Critical Care, and Sleep Medicine, University of South Carolina, Columbia, South Carolina bDivision of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA cDisciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil dRenal and Hypertension Division, University of Pennsylvania Perelman School of Medicine eDivision of Sleep Medicine, Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA fFaculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland gCenter of Sleep Medicine, Charité University Hospital, Berlin, Germany hDepartment of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards iWoodcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia jDepartment of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taiwan, Republic of China kDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
出版信息
J Hypertens. 2014 Dec;32(12):2341-50; discussion 2350. doi: 10.1097/HJH.0000000000000372.
OBJECTIVE
To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).
METHODS
Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.
RESULTS
A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 76%), respectively, in favor of the CPAP group.
CONCLUSION
The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
目的
系统分析探讨持续气道正压通气（CPAP）对难治性高血压合并阻塞性睡眠呼吸暂停（OSA）患者血压（BP）影响的研究。
方法
设计——对PubMed和Ovid（All Journals@Ovid）索引的观察性研究和随机对照试验（RCT）进行荟萃分析。参与者：难治性高血压合并OSA的个体；干预措施——CPAP治疗。
结果
共有六项研究符合干预前至干预后分析的纳入标准。六项研究中CPAP治疗后动态（24小时）收缩压（SBP）和舒张压（DBP）平均变化的合并估计值分别为-7.21 mmHg [95%置信区间（CI）：-9.04至-5.38；P < 0.001；I² 58%]和-4.99 mmHg（95% CI：-6.01至-3.96；P < 0.001；I² 31%）。四项RCT中动态SBP和DBP的合并估计值显示，CPAP组平均净变化分别为-6.74 mmHg [95% CI：-9.98至-3.49；P < 0.001；I² 61%]和-5.94 mmHg（95% CI：-9.40至-2.47；P = 0.001；I² 76%）。
结论
合并估计显示，CPAP治疗可使难治性高血压合并OSA患者的血压显著降低。效应大小大于先前报道的无难治性高血压的OSA患者。
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