Spannella Francesco, Giulietti Federico, Di Pentima Chiara, Lombardi Francesca Elena, Borioni Elisabetta, Sarzani Riccardo
Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.
Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
High Blood Press Cardiovasc Prev. 2017 Sep;24(3):341-346. doi: 10.1007/s40292-017-0190-7. Epub 2017 Mar 21.
Age is one of the main risk factor for the presence of obstructive sleep apnea (OSA). This syndrome is associated with hypertension, cardiovascular disease, cognitive impairment and metabolic abnormalities, such as type 2 diabetes. Continuous positive airway pressure (CPAP) represents the gold standard therapy, but its benefit is still to be determined in very elderly. We report the blood pressure and metabolic changes in a very elderly obese with severe OSA after 3-month CPAP therapy. We have evaluated a very elderly obese male affected by severe symptomatic OSA, poor controlled nocturnal hypertension and insulin resistance. After 3-month CPAP therapy, without any changes in drug therapy, we observed a normalization of circadian blood pressure (BP) pattern, an improved insulin sensitivity, together with a reduced resting energy expenditure, despite no significant change in weight. This case report shows the benefits of OSA treatment with CPAP, not only on BP profile, but also on metabolic parameters in a very elderly, a particular type of patient in which scientific evidence is still scant. Further studies are needed to better investigate the relationship between OSA, CPAP therapy and energy expenditure not only in adults but also in elderly patients.
年龄是阻塞性睡眠呼吸暂停（OSA）存在的主要危险因素之一。该综合征与高血压、心血管疾病、认知障碍和代谢异常（如2型糖尿病）相关。持续气道正压通气（CPAP）是金标准治疗方法，但其对高龄患者的益处仍有待确定。我们报告了一名重度OSA的高龄肥胖患者在接受3个月CPAP治疗后的血压和代谢变化。我们评估了一名受重度症状性OSA、夜间高血压控制不佳和胰岛素抵抗影响的高龄肥胖男性。在3个月的CPAP治疗后，在药物治疗无任何变化的情况下，我们观察到昼夜血压（BP）模式正常化、胰岛素敏感性改善，同时静息能量消耗减少，尽管体重无显著变化。本病例报告显示了CPAP治疗OSA的益处，不仅对血压状况有益，而且对高龄患者（这是一类科学证据仍然匮乏的特殊患者）的代谢参数也有益。需要进一步研究以更好地探究OSA、CPAP治疗与能量消耗之间的关系，不仅在成年人中，而且在老年患者中也是如此。
