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阻塞性睡眠呼吸暂停综合征患者的肾内血流动力学与氧化应激

Intrarenal hemodynamic and oxidative stress in patients with obstructive sleep apnea syndrome.

作者信息

Sardo L, Palange P, Di Mario F, Barbano B, Gigante A, Mordenti M, Steffanina A, Bonini M, Amoroso A, Vaccaro F, Cianci R

机构信息

Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy.

Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

出版信息

Sleep Breath. 2015 Dec;19(4):1205-12. doi: 10.1007/s11325-015-1140-z. Epub 2015 Apr 1.

Abstract

BACKGROUND

Oxygen desaturation and reoxygenation, related to intermittent hypoxia cycles due to upper airway obstruction, are major pathophysiologic features of obstructive sleep apnea syndrome (OSAS) and are thought to be responsible for an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is therefore considered the gold standard in the management of OSAS. Further data demonstrated a high prevalence of OSAS in patients with altered renal function despite the underlying pathophysiological mechanisms that have not been clarified. This study aims to provide evidence on the reported high prevalence of endothelial dysfunction and alterations of the intrarenal hemodynamic in patients affected by OSAS. Furthermore, we evaluated the effect of a CPAP therapy on these endpoints.

METHODS

Twenty patients were enrolled in a prospective study and underwent ultrasound examination to assess endothelial dysfunction, by collecting brachial flow-mediated dilation (FMD) and intrarenal artery stiffness, pre- and post a 30-day treatment with CPAP.

RESULTS

Endothelial dysfunction and intrarenal artery stiffness significantly improved in all patients after a month of CPAP. In particular, we observed a significant reduction in the renal resistance index (RI) (p < 0.001) and systolic/diastolic ratio (S/D) ratio (p < 0.001) and a significant increase of FMD (p < 0.001). The apnea-hypopnea index (AHI) showed a negative correlation with Δ FMD (p < 0.05, r = -0.46). Conversely, a positive correlation exists between Δ RI and the oxygen desaturation index (ODI) (specificare la sigla) (p < 0.05, r = 0.46).

CONCLUSIONS

Our study firstly showed a significant effect of CPAP on renal perfusion and endothelial function in OSAS patients without concomitant cardiovascular comorbidities.

摘要

背景

与上气道阻塞导致的间歇性缺氧周期相关的氧饱和度下降和再氧合是阻塞性睡眠呼吸暂停综合征(OSAS)的主要病理生理特征,被认为是心血管疾病风险增加的原因。因此,持续气道正压通气(CPAP)被认为是OSAS治疗的金标准。进一步的数据表明,尽管潜在的病理生理机制尚未阐明,但肾功能改变的患者中OSAS的患病率很高。本研究旨在为报道的OSAS患者中内皮功能障碍和肾内血流动力学改变的高患病率提供证据。此外,我们评估了CPAP治疗对这些终点的影响。

方法

20名患者参加了一项前瞻性研究,在接受CPAP治疗30天前后,通过收集肱动脉血流介导的扩张(FMD)和肾内动脉僵硬度,进行超声检查以评估内皮功能障碍。

结果

CPAP治疗一个月后,所有患者的内皮功能障碍和肾内动脉僵硬度均有显著改善。特别是,我们观察到肾阻力指数(RI)(p < 0.001)和收缩压/舒张压比值(S/D)显著降低(p < 0.001),FMD显著增加(p < 0.001)。呼吸暂停低通气指数(AHI)与ΔFMD呈负相关(p < 0.05,r = -0.46)。相反,ΔRI与氧饱和度下降指数(ODI)(具体符号)之间存在正相关(p < 0.05,r = 0.46)。

结论

我们的研究首次表明,CPAP对无心血管合并症的OSAS患者的肾灌注和内皮功能有显著影响。

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