Fehrm Johan, Friberg Danielle, Bring Johan, Browaldh Nanna
Department of Otorhinolaryngology, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Otorhinolaryngology, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Sleep Med. 2017 Jun;34:156-161. doi: 10.1016/j.sleep.2017.02.030. Epub 2017 Apr 4.
Obstructive sleep apnea (OSA) is a risk factor for hypertension. The SKUP study showed that modified uvulopalatopharyngoplasty (UPPP) significantly improved nocturnal respiration, sleepiness, and quality of life. The aim of this study was to evaluate the impact of surgery on blood pressure in patients with OSA.
We used a single-center randomized controlled trial to compare modified UPPP with controls at baseline and after six months. The controls received delayed surgery with an additional six-month follow-up. All operated patients also had a follow-up after 24 months. Polysomnography was performed at each follow-up, with systolic and diastolic blood pressure (SBP, DBP) measured the morning after.
A total of 65 patients were randomized to intervention (n = 32) or control (n = 33). At follow-up (n = 61/65, 94%), there were significant differences between the groups in both mean SBP (-9.4 mmHg [95% CI: -17.9, -0.83], p < 0.05) and mean DBP (-6.4 mmHg [95% CI: -12.8, -0.04], p < 0.05), in favor of UPPP. Blood pressure and respiratory parameters at follow-up correlated. The analyses of all operated patients showed a significant decrease in mean (SD) blood pressure after six months (n = 49/65, 75%; SBP: -4.5 [9.0], p = 0.001; DBP: -2.2 [6.6], p = 0.030) as well as after 24 months (n = 35/65, 54%; SBP: -8.9 [11.5], p < 0.0001; DBP: -4.2 [9.4], p = 0.012).
Blood pressure was significantly decreased after surgery, indicating that modified UPPP decreases the blood pressure, in a selected group of patients with moderate to severe OSA. The long-term effect was also significant, but these results are uncertain due to a high proportion of missing values.
NCT01659671.
阻塞性睡眠呼吸暂停（OSA）是高血压的一个危险因素。SKUP研究表明，改良悬雍垂腭咽成形术（UPPP）可显著改善夜间呼吸、嗜睡及生活质量。本研究旨在评估手术对OSA患者血压的影响。
我们采用单中心随机对照试验，在基线及6个月后比较改良UPPP组与对照组。对照组接受延迟手术，并额外随访6个月。所有接受手术的患者在24个月后也进行了随访。每次随访时均进行多导睡眠监测，并于次日早晨测量收缩压和舒张压（SBP、DBP）。
共有65例患者被随机分为干预组（n = 32）或对照组（n = 33）。在随访时（n = 61/65，94%），两组间平均SBP（-9.4 mmHg [95%CI：-17.9，-0.83]，p < 0.05）和平均DBP（-6.4 mmHg [95%CI：-12.8，-0.04]，p < 0.05）均存在显著差异，UPPP组更优。随访时血压与呼吸参数相关。对所有接受手术患者的分析显示，6个月后（n = 49/65，75%；SBP：-4.5 [9.0]，p = 0.001；DBP：-2.2 [6.6]，p = 0.030）以及24个月后（n = 35/65，54%；SBP：-8.9 [11.5]，p < 0.0001；DBP：-4.2 [9.4]，p = 0.012）平均（标准差）血压均显著下降。
手术治疗后血压显著下降，表明改良UPPP可降低部分中重度OSA患者的血压。长期效果也很显著，但由于缺失值比例较高，这些结果尚不确定。
NCT01659671。
