Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, PR China.
Sleep Medicine Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, PR China.
Am J Otolaryngol. 2020 Nov-Dec;41(6):102655. doi: 10.1016/j.amjoto.2020.102655. Epub 2020 Aug 6.
This work is aimed at evaluating the therapeutic effect of continuous positive airway pressure (CPAP) in treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with arrhythmias as well as clarifying the possible mechanism underpinning such an intervention.
Through exclusions, a total of 108 OSAHS patients combined with arrhythmias were enrolled from June 2017 to June 2019 with full clinical information in this work. A computerized permuted block design with varying block stratification and size according to age, sex, AHI and type of arrhythmia was used to randomize 108 patients to CPAP versus sham CPAP for a period of 12-week. All were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. Before and after CPAP treatment, the improvement of various arrhythmias was compared between the CPAP group and the sham-CPAP group. The levels of CRP, IL-6 and TNF-ɑ were measured simultaneously.
During follow-up, the mean (±SD) CPAP pressure used in the CPAP group was 12.3 (±3.1) cm H2O. The use of CPAP and sham CPAP was on average of 5.2 ± 0.56 and 5.1 ± 0.63 h/night, respectively. After 12 weeks of CPAP therapy, the AHI was significantly decreased and the lowest blood oxygen saturation was notably elevated in the CPAP group compared to the sham-CPAP group, P < 0.05. The CPAP therapy, compared with the sham-CPAP group, significantly reduced the incidence of all types of arrhythmia in patients with OSAHS. The level of the c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) was significantly lower in the CPAP group than in the sham-CPAP group (P < 0.05). Pearson correlation analysis showed that the reduction in the incidence of total arrhythmias was positively correlated with the decrease of CRP, IL-6 and TNF-ɑ levels, respectively.
Findings from this work suggest that proper use of CPAP significantly benefits to OSAHS patients combined with arrhythmias, possibly via counteracting the inflammation.
本研究旨在评估持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并心律失常患者的疗效，并阐明其干预的可能机制。
通过排除，本研究纳入了 2017 年 6 月至 2019 年 6 月期间共 108 例 OSAHS 合并心律失常患者的完整临床资料。采用计算机化的随机区组设计，根据年龄、性别、AHI 和心律失常类型进行不同的分层和大小分组，将 108 例患者随机分为 CPAP 组和假 CPAP 组，治疗时间为 12 周。所有患者均接受不变的药物抗心律失常治疗联合 CPAP。比较 CPAP 治疗前后 CPAP 组和假 CPAP 组各种心律失常的改善情况，并同时测量 CRP、IL-6 和 TNF-α 水平。
在随访过程中，CPAP 组的平均（±SD）CPAP 压力为 12.3（±3.1）cmH2O。CPAP 和假 CPAP 的使用时间平均为 5.2±0.56 和 5.1±0.63 小时/夜。CPAP 治疗 12 周后，CPAP 组的 AHI 明显降低，最低血氧饱和度明显升高，与假 CPAP 组相比，差异有统计学意义（P<0.05）。与假 CPAP 组相比，CPAP 治疗显著降低了 OSAHS 患者各种类型心律失常的发生率。CPAP 组的 C 反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平明显低于假 CPAP 组（P<0.05）。Pearson 相关分析显示，总心律失常发生率的降低与 CRP、IL-6 和 TNF-α 水平的降低呈正相关。
本研究结果表明，CPAP 的合理应用对 OSAHS 合并心律失常患者有益，可能通过抑制炎症发挥作用。
