持续气道正压通气治疗对高危睡眠呼吸暂停患者动态血压的影响：一项随机对照试验。
Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial.
机构信息
Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Medicine, Joseph Brant Hospital, Burlington, Ontario, Canada.
出版信息
J Clin Sleep Med. 2022 Aug 1;18(8):1899-1907. doi: 10.5664/jcsm.10012.
STUDY OBJECTIVES
The long-term effect of continuous positive airway pressure (CPAP) on 24-hour blood pressure (BP) in patients at high risk with obstructive sleep apnea (OSA) is uncertain. We aimed to determine the effect of CPAP treatment on ambulatory BP in individuals with moderate or severe OSA and cardiovascular disease or multiple cardiovascular disease risk factors without severe sleepiness.
METHODS
In this randomized, controlled, parallel group study, 169 participants were randomly assigned to CPAP treatment or the control group. The primary outcome was the change in mean 24-hour systolic BP between groups from baseline to the average of 6- and 12-month measurements using mixed-effect linear regression models.
RESULTS
The 24-hour systolic BP did not significantly differ by group, although there was a trend of decrease in the CPAP group (treatment effect -2.7 mm Hg [95% confidence interval -5.9 to 0.6]; = .105) compared with control. CPAP had the greatest effect on nighttime systolic BP (treatment effect -5.9 mm Hg [95% confidence interval -9.9 to -1.9]; = .004). Similar improvements in other nocturnal BP indices were observed.
CONCLUSIONS
In patients at high risk with moderate-severe OSA without severe sleepiness, CPAP resulted in modest BP improvements over 6 to 12 months of follow-up, with possibly larger effects for nocturnal BP. Use of office blood pressure may underestimate the effect of CPAP on BP profile in patients with OSA.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Title: Sleep Apnea Intervention for Cardiovascular Disease Reduction; Identifier: NCT01261390; URL: https://clinicaltrials.gov/ct2/show/NCT01261390.
CITATION
Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial. . 2022;18(8):1899-1907.
研究目的
持续气道正压通气（CPAP）对合并阻塞性睡眠呼吸暂停（OSA）的高危患者 24 小时血压（BP）的长期影响尚不确定。我们旨在确定 CPAP 治疗对中重度 OSA 且无严重嗜睡、合并心血管疾病或多种心血管疾病危险因素患者的动态血压的影响。
方法
这是一项随机、对照、平行分组研究，共纳入 169 名参与者，随机分为 CPAP 治疗组或对照组。主要结局为采用混合效应线性回归模型，从基线到 6 个月和 12 个月测量的平均值，比较两组 24 小时平均收缩压的变化。
结果
CPAP 组和对照组之间的 24 小时收缩压无显著差异，但 CPAP 组呈下降趋势（治疗效果-2.7mmHg[95%置信区间-5.9 至 0.6]；=0.105）。CPAP 对夜间收缩压的影响最大（治疗效果-5.9mmHg[95%置信区间-9.9 至-1.9]；=0.004）。观察到其他夜间 BP 指标也有类似的改善。
结论
在无严重嗜睡的中重度 OSA 高危患者中，CPAP 在 6 至 12 个月的随访中可使血压适度改善，对夜间血压的影响可能更大。在 OSA 患者中，诊室血压的使用可能低估了 CPAP 对血压谱的影响。
临床试验注册
注册：ClinicalTrials.gov；标题：睡眠呼吸暂停干预降低心血管疾病风险；标识符：NCT01261390；网址：https://clinicaltrials.gov/ct2/show/NCT01261390。
引用
Zhao YY, Wang R, Gleason KJ, et al. Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial.. 2022;18(8):1899-1907.
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