阻塞性睡眠呼吸暂停患者在使用和不使用 CPAP 时的静息和加压挑战期间的压力感受反射敏感性。

Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP.

机构信息

UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.

Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA.

出版信息

Sleep Med. 2022 Sep;97:73-81. doi: 10.1016/j.sleep.2022.05.846. Epub 2022 Jun 4.

INTRODUCTION

Obstructive sleep apnea (OSA) increases sympathetic vasoconstrictor drive and reduces baroreflex sensitivity (BRS), the degree to which blood pressure changes modify cardiac output. Whether nighttime continuous positive airway pressure (CPAP) corrects BRS in the awake state in OSA remains unclear. We assessed spontaneous BRS using non-invasive continuous BP and ECG recordings at rest and during handgrip and Valsalva challenges, maneuvers that increase vasoconstrictor drive with progressively higher BP, in untreated OSA (unOSA), CPAP-treated OSA (cpOSA) and healthy (CON) participants.

METHODS

In a cross-sectional study of 104 participants, 34 unOSA (age mean±std, 50.6±14.1years; Respiratory Event Index [REI] 21.0±15.3 events/hour; 22male), 31 cpOSA (49.6±14.5years; REI 23.0±14.2 events/hour; 22male; self-report 4+hours/night,5+days/week,6months), and 39 CON (42.2±15.0years; 17male), we calculated BRS at rest and during handgrip and Valsalva. Additionally, we correlated BP variability (BPV) with BRS during these protocols.

RESULTS

BRS in unOSA, cpOSA and CON was, respectively (mean±sdv in ms/mmHg), at rest: 14.8±11.8, 15.8±17.0, 16.1±11.3; during handgrip 13.3±7.6, 12.7±8.4, 16.4±8.7; and during Valsalva 12.7±8.0, 11.5±6.6, 15.1±8.9. BRS was lower in cpOSA than CON for handgrip (p=0.04) and Valsalva (p=0.03). BRS was negatively correlated with BPV in unOSA during Valsalva and handgrip for cpOSA, both R=-0.4 (p=0.02). BRS was negatively correlated with OSA severity (levels: none, mild, moderate, severe) at R=-0.2 (p=0.04,n=104).

CONCLUSIONS

As expected, BRS was lower and BPV higher in OSA during the pressor challenges, and disease severity negatively correlated with BRS. In this cross-sectional study, both CPAP-treated (self-reported) and untreated OSA showed reduced BRS, leaving open whether within-person CPAP improves BRS.

简介

阻塞性睡眠呼吸暂停（OSA）会增加交感血管收缩驱动并降低压力反射敏感性（BRS），即血压变化改变心输出量的程度。在未经治疗的 OSA（unOSA）中，夜间持续气道正压通气（CPAP）是否能纠正清醒状态下的 BRS 仍不清楚。我们使用非侵入性连续血压和心电图记录，在休息时以及进行握力和瓦尔萨尔瓦动作时评估自发性 BRS，这些动作会随着血压的升高而逐渐增加血管收缩驱动。在未经治疗的 OSA（unOSA）、CPAP 治疗的 OSA（cpOSA）和健康（CON）参与者中进行了评估。

方法

在一项涉及 104 名参与者的横断面研究中，34 名未经治疗的 OSA（年龄平均值±标准差，50.6±14.1 岁；呼吸事件指数 [REI] 21.0±15.3 次/小时；22 名男性）、31 名 CPAP 治疗的 OSA（49.6±14.5 岁；REI 23.0±14.2 次/小时；22 名男性；自我报告每晚 4+小时，每周 5+天，持续 6 个月）和 39 名健康对照组（CON）（42.2±15.0 岁；17 名男性），我们在休息时以及进行握力和瓦尔萨尔瓦动作时计算了 BRS。此外，我们还在这些方案中对 BPV 与 BRS 进行了相关性分析。

结果

unOSA、cpOSA 和 CON 的 BRS（分别为 ms/mmHg 的平均值±标准偏差）分别为：休息时：14.8±11.8、15.8±17.0、16.1±11.3；握力时：13.3±7.6、12.7±8.4、16.4±8.7；瓦尔萨尔瓦动作时：12.7±8.0、11.5±6.6、15.1±8.9。与 CON 相比，cpOSA 的握力（p=0.04）和瓦尔萨尔瓦动作（p=0.03）的 BRS 较低。CPAP 治疗的 OSA 在瓦尔萨尔瓦和握力时，BRS 与 BPV 呈负相关，两者的 R 值均为-0.4（p=0.02）。BRS 与 OSA 严重程度（水平：无、轻度、中度、重度）呈负相关，R 值为-0.2（p=0.04，n=104）。