Serinel Yasmina, Hoyos Camilla, Qasem Ahmad, Yee Brendon J, Grunstein Ronald R, Wong Keith H, Phillips Craig L
NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia.
The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
Int J Cardiol Hypertens. 2019 Apr 9;1:100002. doi: 10.1016/j.ijchy.2019.100002. eCollection 2019 May.
Recent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA).
In this observational study, patients with moderate to severe OSA underwent 24 h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times.
36 patients were screened, 31 had successful testing (mean (SD) age 45 ± 10 years, AHI 58 ± 27 events/hr, Office BP 136/89 ± 10.7/9.5 mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (-3.2 mmHg, p < 0.001), whereas the central PP remained unchanged (0.124 mmHg, NS), causing a significant reduction in PPA overnight (-10.7%, p < 0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 mmHg, p < 0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by -3.3%, p = 0.004).
In moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.
近期证据表明，与外周血压（BP）相比，中心血压可能与靶器官损害以及心血管发病率和死亡率的关联更为密切。技术进步使得现在能够进行24小时外周和中心血压的动态测量。我们首次着手描述阻塞性睡眠呼吸暂停（OSA）患者中心血压的昼夜变化情况以及脉压放大（PPA）情况。
在这项观察性研究中，中重度OSA患者在接受至少4周持续气道正压通气（CPAP）治疗前后，进行了24小时中心和外周血压测试。同时进行活动记录仪监测以确认睡眠和清醒时间。
共筛查了36例患者，31例测试成功（平均（标准差）年龄45±10岁，呼吸暂停低通气指数（AHI）58±27次/小时，诊室血压136/89±10.7/9.5 mmHg，32%服用抗高血压药物，77%为杓型血压者），21例在CPAP治疗后完成测试。中心收缩压和舒张压与外周血压遵循相同的夜间下降模式，然而外周脉压（PP）在睡眠时变窄（-3.2 mmHg，p<0.001），而中心PP保持不变（0.124 mmHg，无统计学意义），导致夜间PPA显著降低（-10.7%，p<0.001）。中心收缩压的下降幅度小于外周收缩压（相差2.3 mmHg，p<0.001）。CPAP治疗后，夜间PPA降低幅度减弱（-3.3%，p = 0.004）。
在中重度OSA患者中，睡眠期间中心血压和PPA夜间降低。需要进一步的随机对照研究来量化CPAP和抗高血压药物对中心血压与外周血压的不同影响。
