Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Eur Respir J. 2017 Nov 16;50(5). doi: 10.1183/13993003.01261-2017. Print 2017 Nov.
Our aim was to assess the effect of continuous positive airway pressure (CPAP) on the nocturnal evolution of peripheral chemosensitivity, renin-angiotensin-aldosterone system activity, sympathetic tone and endothelial biomarkers in obstructive sleep apnoea (OSA) patients with isolated nocturnal hypertension (INH) or day-night sustained hypertension (D-NSH).In a crossover randomised trial, 32 OSA patients newly diagnosed with hypertension and without antihypertensive treatment were randomly assigned to 12 weeks of CPAP or sham CPAP. Peripheral chemosensitivity was evaluated before and after sleep using the hypoxic withdrawal test (%Δ).At baseline, D-NSH patients showed higher %Δ before sleep and higher levels of aldosterone and diurnal catecholamines. CPAP only reduced the nocturnal increase of %Δ in INH patients (6.9%, 95% CI 1.0-12.8%; p=0.026). CPAP-induced change from baseline in %Δ after sleep was 7.5% (95% CI 2.6-12.2%, p=0.005) in the INH group and 5.7% (95% CI 2.2-9.3%, p=0.004) in the D-NSH group. In contrast, %Δ before sleep only decreased with CPAP in the D-NSH patients (3.0%, 95% CI 0.5-5.6%; p=0.023).In conclusion, CPAP reduces the nocturnal increase of peripheral chemosensitivity experienced by INH patients and corrects the high daytime sensitivity of patients with D-NSH. Differences in response to CPAP between these patients can help better understand the mechanisms of perpetuation of hypertension in sleep apnoea.
我们的目的是评估持续气道正压通气（CPAP）对孤立性夜间高血压（INH）或昼夜持续高血压（D-NSH）的阻塞性睡眠呼吸暂停（OSA）患者夜间外周化学敏感性、肾素-血管紧张素-醛固酮系统活性、交感神经活性和内皮生物标志物变化的影响。在一项交叉随机试验中，32 名新诊断为高血压且未接受降压治疗的 OSA 患者被随机分为 CPAP 组或假 CPAP 组，接受 12 周的治疗。使用低氧脱逸试验（%Δ）在睡眠前后评估外周化学敏感性。在基线时，D-NSH 患者在睡眠前的 %Δ更高，醛固酮和日间儿茶酚胺水平更高。CPAP 仅降低了 INH 患者的夜间 %Δ增加（6.9%，95%CI 1.0-12.8%；p=0.026）。CPAP 诱导的睡眠后 %Δ的变化在 INH 组为 7.5%（95%CI 2.6-12.2%，p=0.005），在 D-NSH 组为 5.7%（95%CI 2.2-9.3%，p=0.004）。相比之下，在 D-NSH 患者中，只有 CPAP 能降低睡眠前的 %Δ（3.0%，95%CI 0.5-5.6%；p=0.023）。总之，CPAP 降低了 INH 患者夜间外周化学敏感性的增加，并纠正了 D-NSH 患者白天敏感性过高的问题。这些患者对 CPAP 的反应差异有助于更好地理解睡眠呼吸暂停中高血压持续存在的机制。
