Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Scand Cardiovasc J. 2020 Feb;54(1):26-31. doi: 10.1080/14017431.2019.1659395. Epub 2019 Sep 3.
To enhance the initial compliance of continuous positive airway pressure (CPAP) in the patient with obstructive sleep apnea (OSA), we investigate the acute effects of one-night CPAP on morning blood pressure (BP) and, if any exist, to determine which factors predict BP-lowering effects of one-night CPAP in OSA subgroups stratified by the presence or absence of uncontrolled hypertension. Newly diagnosed OSA patients (a respiratory distress index (RDI) ≥ 15) without a history of hypertension were stratified by the presence or absence of morning hypertension. Comparisons were made of morning BP, overnight change in mean BP (MBP), and circadian BP pattern (R, the ratio of morning to evening MBP) between two time points of diagnostic and CPAP titrations in each subgroup. In the subgroup with a significantly reduced morning BP, predictors of changes in morning MBP were determined by multiple linear regression analyses. The prevalence of morning hypertension was 48.8%. One-night CPAP reduced BP immediately only in patients with morning hypertension. By contrast, patients without morning hypertension did not experience any BP-lowering effects. In the subgroup with morning hypertension, baseline morning MBP, female sex, and R were independently associated with reduced morning MBP, and R was the most important predictor. These results confirm the acute effects of one-night CPAP on lowering BP in OSA patients with morning hypertension. An unfavorable circadian BP pattern is the most important predictor.
为了提高阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气（CPAP）的初始依从性，我们研究了一夜间 CPAP 对清晨血压（BP）的急性影响，如果存在这种影响，则确定哪些因素可以预测 OSA 亚组中一夜 CPAP 的降压效果，这些亚组根据是否存在不受控制的高血压进行分层。无高血压病史的新诊断 OSA 患者（呼吸窘迫指数（RDI）≥15）根据清晨高血压的存在与否进行分层。在每个亚组的诊断和 CPAP 滴定的两个时间点比较清晨 BP、夜间平均 BP（MBP）变化和昼夜 BP 模式（R，即清晨与傍晚 MBP 的比值）。在清晨 BP 明显降低的亚组中，通过多元线性回归分析确定清晨 MBP 变化的预测因素。清晨高血压的患病率为 48.8%。只有在清晨高血压的患者中，一夜间 CPAP 才能立即降低血压。相比之下，没有清晨高血压的患者没有经历任何降压效果。在清晨高血压的亚组中，基线清晨 MBP、女性和 R 与清晨 MBP 降低独立相关，而 R 是最重要的预测因素。这些结果证实了一夜间 CPAP 对清晨高血压 OSA 患者降低血压的急性作用。不利的昼夜 BP 模式是最重要的预测因素。
