Jennum P, Wildschiødtz G, Christensen N J, Schwartz T
Department of Clinical Neurophysiology, Glostrup Hospital, Denmark.
Am J Hypertens. 1989 Nov;2(11 Pt 1):847-52. doi: 10.1093/ajh/2.11.847.
In order to study blood pressure, adrenergic, and cholinergic activity in severe obstructive sleep apnea (OSA), 14 patients with apnea index (AI) greater than 30 apneas/h, mean apnea time index greater than 20 sec were studied before and with nasal Continuous Positive Airway Pressure (nCPAP). Sleep, respiration, arterial blood pressure, arterial plasma catecholamines [norepinephrine (NE) and epinephrine (E)], and plasma pancreatic polypeptide (PP) were measured without and after seven days treatment with nCPAP. Initially in the apnea, arterial blood pressure decreases, and thereafter steadily increases and shows a maximum during the first breath terminating the apnea. With nCPAP the arterial pressure variations disappeared. Awake morning systolic (SBP) and diastolic (DBP) blood pressure decreased the nCPAP treatment. A significant relation between the reduction in AI and the reduction in morning awake SBP and DBP with nCPAP treatment was observed. No significant changes in NE were observed with nCPAP treatment. Epinephrine decreased and PP increased significantly with nasal nCPAP treatment. The systolic and diastolic blood pressure reduction was significantly related to the decrease in E and the increase in PP. No association between sleep stages and plasma NE, E, and plasma-PP was found before treatment. With nCPAP treatment plasma-PP was higher during non-rapid eye movement (NREM) stage 2 to 4 sleep than during rapid eye movement (REM) sleep. Thus, morning awake arterial blood pressure and nocturnal arterial blood pressure decrease with nCPAP treatment in sleep apnea patients. These hemodynamic changes are related to the decrease in AI and sympathetic activity and the increase in parasympathetic activity.
为了研究重度阻塞性睡眠呼吸暂停（OSA）患者的血压、肾上腺素能和胆碱能活性，我们对14名呼吸暂停指数（AI）大于30次呼吸暂停/小时、平均呼吸暂停时间指数大于20秒的患者在使用鼻持续气道正压通气（nCPAP）之前和使用期间进行了研究。在未使用nCPAP治疗7天以及治疗后，分别测量了患者的睡眠、呼吸、动脉血压、动脉血浆儿茶酚胺[去甲肾上腺素（NE）和肾上腺素（E）]以及血浆胰多肽（PP）。最初在呼吸暂停时，动脉血压下降，随后稳步上升，并在终止呼吸暂停的第一次呼吸时达到最大值。使用nCPAP后，动脉压变化消失。nCPAP治疗后，清醒状态下的早晨收缩压（SBP）和舒张压（DBP）下降。观察到AI的降低与nCPAP治疗后早晨清醒时SBP和DBP的降低之间存在显著相关性。nCPAP治疗后未观察到NE有显著变化。鼻nCPAP治疗后，肾上腺素降低，PP显著升高。收缩压和舒张压的降低与E的降低和PP的升高显著相关。治疗前未发现睡眠阶段与血浆NE、E和血浆PP之间存在关联。使用nCPAP治疗后，非快速眼动（NREM）睡眠2至4期的血浆PP高于快速眼动（REM）睡眠期。因此，睡眠呼吸暂停患者使用nCPAP治疗后，早晨清醒时的动脉血压和夜间动脉血压会降低。这些血流动力学变化与AI的降低、交感神经活动的降低以及副交感神经活动的增加有关。
