Khurshid Kiran, Yabes Jonathan, Weiss Patricia M, Dharia Sushma, Brown Lee, Unruh Mark, Jhamb Manisha
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Clin Sleep Med. 2016 Aug 15;12(8):1143-51. doi: 10.5664/jcsm.6054.
Obstructive sleep apnea (OSA) is an independent risk factor for hypertension (HTN). Increasing evidence from animal and human studies suggests that HTN exacerbates OSA. We performed a systematic review and meta-analysis of studies evaluating the effect of anti-hypertensive medications on the severity of OSA.
A literature search of PubMed and Embase was done using search concepts of OSA, HTN, and drug classes used to treat HTN. Studies that reported changes in the severity of OSA objectively by using apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) were included. Pooled mean difference estimates were calculated. Tests for heterogeneity, publication bias, and subgroup sensitivity analysis were conducted.
Of 27,376 studies screened, only 11 met inclusion criteria, including 5 randomized controlled trials and 6 single-arm prospective trials. The pooled mean difference estimate (95% confidence interval [CI]), based on a random-effects model, was -5.69 (95% CI -10.74 to -0.65), consistent with an overall decrease in AHI or RDI attributable to antihypertensive medications. The effect size was even more pronounced, -14.52 (95% CI -25.65 to -3.39), when only studies using diuretics were analyzed. There was no significant heterogeneity or publication bias among the studies. Meta-regression indicated neither age, baseline AHI, nor change in systolic/diastolic blood pressure influenced the results.
Collectively, findings from these relatively small, short-term studies tend to support the contention that treatment with antihypertensive agents confers a statistically significant, albeit small, reduction in the severity of OSA, which may be more pronounced with the use of diuretics.
阻塞性睡眠呼吸暂停（OSA）是高血压（HTN）的独立危险因素。来自动物和人体研究的越来越多的证据表明，高血压会加重阻塞性睡眠呼吸暂停。我们对评估抗高血压药物对阻塞性睡眠呼吸暂停严重程度影响的研究进行了系统评价和荟萃分析。
使用阻塞性睡眠呼吸暂停、高血压以及用于治疗高血压的药物类别等检索词，对PubMed和Embase进行文献检索。纳入那些通过使用呼吸暂停低通气指数（AHI）或呼吸紊乱指数（RDI）客观报告阻塞性睡眠呼吸暂停严重程度变化的研究。计算合并平均差估计值。进行异质性检验、发表偏倚检验和亚组敏感性分析。
在筛选的27376项研究中，只有11项符合纳入标准，包括5项随机对照试验和6项单臂前瞻性试验。基于随机效应模型的合并平均差估计值（95%置信区间[CI]）为-5.69（95%CI -10.74至-0.65），这与抗高血压药物导致AHI或RDI总体下降一致。仅分析使用利尿剂的研究时，效应量更为显著，为-14.52（95%CI -25.65至-3.39）。研究之间没有显著的异质性或发表偏倚。Meta回归表明，年龄、基线AHI以及收缩压/舒张压的变化均未影响结果。
总体而言，这些相对较小规模的短期研究结果倾向于支持以下观点，即抗高血压药物治疗可使阻塞性睡眠呼吸暂停的严重程度在统计学上有显著降低，尽管降低幅度较小，使用利尿剂时这种降低可能更为明显。
